Active NPI
Susie Yang
- Pharmacist
- Staten Island, NY
National Provider Identifier
1154895290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0014215
- Practice address
- 2690 Hylan Blvd
Staten Island, NY 10306-4336 - Phone
- (718) 987-9727
- NPI assigned
- Jan 11, 2019
- Last updated
- Sep 28, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 065038 | NY | |
| Pharmacist | 183500000X | 0014215 | CT | Primary |
Addresses
Primary practice location
2690 Hylan Blvd
Staten Island, NY 10306-4336
Mailing address
1836 Hylan Blvd Ste B
Staten Island, NY 10305-1935
Phone (917) 565-8666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0014215 | CT | MD | Pharmacist |
| 065038 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunning Pharmacy Inc. | Current | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients | |
| Connecticut CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Connecticut CVS Pharmacy LLC | Past | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients |
Locations
1836 Hylan Blvd
Ste B
Staten Island, NY 10305
Phone (917) 565-8666
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Staten Island, NY
- NPI 1013547629
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695859200000",
"number": "1154895290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1836 HYLAN BLVD STE B",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103051935",
"telephone_number": "917-565-8666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2690 HYLAN BLVD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103064336",
"telephone_number": "718-987-9727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YANG",
"first_name": "SUSIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-11",
"last_updated": "2023-09-28",
"certification_date": "2023-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "065038",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "0014215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.