Provider Demographics
NPI:1932155801
Name:YANG, AJAX (MD)
Entity Type:Individual
Prefix:
First Name:AJAX
Middle Name:
Last Name:YANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1922
Mailing Address - Country:US
Mailing Address - Phone:718-667-3577
Mailing Address - Fax:
Practice Address - Street 1:1534 VICTORY BLVD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3548
Practice Address - Country:US
Practice Address - Phone:718-667-3577
Practice Address - Fax:718-667-3040
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2929802081P2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine