Provider Demographics
NPI:1437474970
Name:SALUS MEDICAL FLUSHING PC
Entity Type:Organization
Organization Name:SALUS MEDICAL FLUSHING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JC
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-9098
Mailing Address - Street 1:41-40 UNION STREET
Mailing Address - Street 2:#2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2540
Mailing Address - Country:US
Mailing Address - Phone:718-886-9098
Mailing Address - Fax:718-886-2086
Practice Address - Street 1:41-40 UNION STREET
Practice Address - Street 2:#2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2540
Practice Address - Country:US
Practice Address - Phone:718-886-9098
Practice Address - Fax:718-886-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-27
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03205227Medicaid
NY03205227Medicaid