Provider Demographics
NPI:1942287982
Name:TAK, YONG SUK (MD CPMR)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:SUK
Last Name:TAK
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Gender:M
Credentials:MD CPMR
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Mailing Address - Street 1:3399 HAROLD ST
Mailing Address - Street 2:GLOBAL MEDICAL PHYSICIAN PC DR YONG S TAK MD
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4720
Mailing Address - Country:US
Mailing Address - Phone:516-623-6600
Mailing Address - Fax:516-223-9539
Practice Address - Street 1:8037 BROADWAY
Practice Address - Street 2:GLOBAL MEDICAL PHYSICIAN PC DR YONG S TAK MD
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3160
Practice Address - Country:US
Practice Address - Phone:516-623-6600
Practice Address - Fax:516-223-9539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY206576208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02023572Medicaid
NY03559HMedicare ID - Type Unspecified