1942287982 NPI number — DR. YONG SUK TAK MD CPMR

Table of content: DR. YONG SUK TAK MD CPMR (NPI 1942287982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942287982 NPI number — DR. YONG SUK TAK MD CPMR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAK
Provider First Name:
YONG
Provider Middle Name:
SUK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD CPMR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942287982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3399 HAROLD ST
Provider Second Line Business Mailing Address:
GLOBAL MEDICAL PHYSICIAN PC DR YONG S TAK MD
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11572-4720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-623-6600
Provider Business Mailing Address Fax Number:
516-223-9539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8037 BROADWAY
Provider Second Line Business Practice Location Address:
GLOBAL MEDICAL PHYSICIAN PC DR YONG S TAK MD
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-623-6600
Provider Business Practice Location Address Fax Number:
516-223-9539
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  206576 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02023572 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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