Provider Demographics
NPI:1710019815
Name:YONGMING MAO PHYSICIAN PC
Entity Type:Organization
Organization Name:YONGMING MAO PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YONGMING
Authorized Official - Middle Name:
Authorized Official - Last Name:MAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-690-8682
Mailing Address - Street 1:1675 W 1ST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1675 W 1ST ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1744
Practice Address - Country:US
Practice Address - Phone:718-690-8682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2338172084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02758881Medicaid
NY02758881Medicaid
NJ103043Medicare ID - Type Unspecified