Provider Demographics
NPI:1205372216
Name:BY WOUND CARE INTERNAL MEDICINE P.C.
Entity type:Organization
Organization Name:BY WOUND CARE INTERNAL MEDICINE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYOUNG
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-422-5712
Mailing Address - Street 1:34 S BROADWAY STE 114
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4432
Mailing Address - Country:US
Mailing Address - Phone:914-422-5712
Mailing Address - Fax:914-422-5714
Practice Address - Street 1:34 S BROADWAY STE 114
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-422-5712
Practice Address - Fax:914-422-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2648372083P0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY264837OtherMEDICAL LICENSE
NY03523080Medicaid
000645301Medicare PIN