Provider Demographics
NPI:1407238595
Name:ENG, YENNY
Entity Type:Individual
Prefix:MRS
First Name:YENNY
Middle Name:
Last Name:ENG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:YENNY
Other - Middle Name:
Other - Last Name:PURNAWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:35 MONTGOMERY ST
Mailing Address - Street 2:APT. 15B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6558
Mailing Address - Country:US
Mailing Address - Phone:646-591-8257
Mailing Address - Fax:
Practice Address - Street 1:4277 65TH PL
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5054
Practice Address - Country:US
Practice Address - Phone:718-429-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY746445390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program