Provider Demographics
NPI:1619592466
Name:YI, BINBIN
Entity Type:Individual
Prefix:MRS
First Name:BINBIN
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1631
Mailing Address - Country:US
Mailing Address - Phone:617-955-2629
Mailing Address - Fax:
Practice Address - Street 1:58 MAPLE ST STE 300
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4160
Practice Address - Country:US
Practice Address - Phone:203-709-6646
Practice Address - Fax:203-709-5288
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282100163W00000X
CT8987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse