Provider Demographics
NPI:1487955688
Name:RENATO YU M.D. F.A.A.P., P.C.
Entity type:Organization
Organization Name:RENATO YU M.D. F.A.A.P., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-898-1515
Mailing Address - Street 1:7506 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1207
Mailing Address - Country:US
Mailing Address - Phone:718-898-1515
Mailing Address - Fax:718-533-9072
Practice Address - Street 1:7506 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1207
Practice Address - Country:US
Practice Address - Phone:718-898-1515
Practice Address - Fax:718-533-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02093667Medicaid
NY02921933Medicaid