Provider Demographics
NPI:1417020058
Name:YDR GERIATRICS & NEPHROLOGY LLP
Entity Type:Organization
Organization Name:YDR GERIATRICS & NEPHROLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JINIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:718-920-9040
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-9239
Mailing Address - Country:US
Mailing Address - Phone:914-263-7562
Mailing Address - Fax:914-633-5084
Practice Address - Street 1:4141 CARPENTER AVE
Practice Address - Street 2:RENAL UNIT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2600
Practice Address - Country:US
Practice Address - Phone:718-920-9041
Practice Address - Fax:914-633-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3300305OtherGHI
2672995OtherAETNA
NY00740818Medicaid
3300305OtherGHI