Provider Demographics
NPI:1922564749
Name:YIM, SUYON (NP)
Entity type:Individual
Prefix:
First Name:SUYON
Middle Name:
Last Name:YIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 NEDELLEC DR
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5140
Mailing Address - Country:US
Mailing Address - Phone:201-294-7268
Mailing Address - Fax:
Practice Address - Street 1:300 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6300
Practice Address - Country:US
Practice Address - Phone:201-567-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14486900163W00000X
NY310723363L00000X
NJ26NJ00882400363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty