1417944984 NPI number — DR. RICHARD ASIS YOUNG M.D.

Table of content: DR. RICHARD ASIS YOUNG M.D. (NPI 1417944984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417944984 NPI number — DR. RICHARD ASIS YOUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
RICHARD
Provider Middle Name:
ASIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1417944984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10230 66TH ROAD
Provider Second Line Business Mailing Address:
30H
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-7623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-756-4908
Provider Business Mailing Address Fax Number:
877-299-9287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 BROADWAY
Provider Second Line Business Practice Location Address:
ROOM H3-27
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-334-1501
Provider Business Practice Location Address Fax Number:
718-334-5721
Provider Enumeration Date:
09/30/2005

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: 2084P0800X , with the licence number:  201199 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7620317 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01987806 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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