1033162854 NPI number — DENISE M. YOUNG-AJOSE MD, MPH

Table of content: DENISE M. YOUNG-AJOSE MD, MPH (NPI 1033162854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033162854 NPI number — DENISE M. YOUNG-AJOSE MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG-AJOSE
Provider First Name:
DENISE
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033162854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 BROADWAY PH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10012-2614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-943-8131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
632 BROADWAY PH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10012-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-943-8131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MA08025500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD-14650 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2673709 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K6389 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4865P1 . This is a "EMPIRE BC/BS NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3755509 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0725268 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1454540 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000278218 . This is a "HMSA BILLING NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0106992 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 622565-02 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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