Provider Demographics
NPI:1518439579
Name:LEGACYIVF
Entity Type:Organization
Organization Name:LEGACYIVF
Other - Org Name:MINGXUE YANG MEDICAL PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-369-8700
Mailing Address - Street 1:1625 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3637
Mailing Address - Country:US
Mailing Address - Phone:212-369-8700
Mailing Address - Fax:
Practice Address - Street 1:1625 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3637
Practice Address - Country:US
Practice Address - Phone:212-369-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02993566Medicaid
NY234908OtherOBSTETRICS AND GYNECOLOGY