Provider Demographics
NPI:1740593920
Name:YANG-NOVELLINO, SUE
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:YANG-NOVELLINO
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 1:504 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08107
Mailing Address - Country:US
Mailing Address - Phone:856-425-2577
Mailing Address - Fax:856-282-5610
Practice Address - Street 1:504 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08107
Practice Address - Country:US
Practice Address - Phone:856-425-2577
Practice Address - Fax:856-282-5610
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09235900207Q00000X
PAOS017234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine