Provider Demographics
NPI:1477643468
Name:MONONGALIA PEDIATRIC & YOUTH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MONONGALIA PEDIATRIC & YOUTH ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAP-YANG
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-599-2004
Mailing Address - Street 1:1202 SUNCREST TOWNE CENTRE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1828
Mailing Address - Country:US
Mailing Address - Phone:304-599-2004
Mailing Address - Fax:304-599-7611
Practice Address - Street 1:1202 SUNCREST TOWNE CENTRE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1828
Practice Address - Country:US
Practice Address - Phone:304-599-2004
Practice Address - Fax:304-599-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory