Provider Demographics
NPI:1508977943
Name:YOO, SANG W (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:W
Last Name:YOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1629
Mailing Address - Country:US
Mailing Address - Phone:973-667-8800
Mailing Address - Fax:973-284-1100
Practice Address - Street 1:245 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1629
Practice Address - Country:US
Practice Address - Phone:973-667-8800
Practice Address - Fax:973-284-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA328832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1579801Medicaid
NJ1579801Medicaid
NJ470856Medicare ID - Type Unspecified