1477508729 NPI number — DR. PAULA D YOUNG I M.D.

Table of content: DR. PAULA D YOUNG I M.D. (NPI 1477508729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477508729 NPI number — DR. PAULA D YOUNG I M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
PAULA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
M.D.
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:
1477508729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2280 GRAND AVE
Provider Second Line Business Mailing Address:
SUITE 307
Provider Business Mailing Address City Name:
BALDWIN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11510-3164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-398-0029
Provider Business Mailing Address Fax Number:
516-378-1045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2280 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
BALDWIN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11510-3164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-398-0029
Provider Business Practice Location Address Fax Number:
516-378-1045
Provider Enumeration Date:
05/24/2006

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: 207R00000X , with the licence number:  178888 , 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: 01663161 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2156275 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10779768 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 30L87 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1423639 . This is a "UNITEDHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1959239 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0007098316 . This is a "AETNA LIFE INS CO" identifier . This identifiers is of the category "OTHER".




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