Provider Demographics
NPI:1881774636
Name:YEO, YOUNG JOO (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNG JOO
Middle Name:
Last Name:YEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1739
Mailing Address - Country:US
Mailing Address - Phone:631-269-5197
Mailing Address - Fax:
Practice Address - Street 1:452 SUFFOLK AVE
Practice Address - Street 2:ACCESS/ACCESO
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-436-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130869251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY130869OtherNY STATE MEDICAL LICENSE
NYAY998769OtherDEA#
NYF37223Medicare UPIN