Individual
MR. GARY YAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794
(631) 942-4613
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794
(631) 942-4613
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
652027
NY
363LA2100X
Acute Care Nurse Practitioner
F431347-01
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
652027-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
652027
NYSED NEW YORK STATE EDUCATION DEPARTMENT
NY
Enumeration date
01/17/2018
Last updated
11/22/2024
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