1578732988 NPI number — DALTON YOUNG

Table of content: DALTON YOUNG (NPI 1578732988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578732988 NPI number — DALTON YOUNG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
DALTON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
DALTON
Provider Other Middle Name:
O
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578732988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2042 SCENIC VIEW LN
Provider Second Line Business Mailing Address:
APT 6B
Provider Business Mailing Address City Name:
HELLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-838-1520
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
492 ROUTE 57 WEST
Provider Second Line Business Practice Location Address:
FAMILY GUIDANCE CENTER OF WARREN COUNTY
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-689-1000
Provider Business Practice Location Address Fax Number:
908-689-4529
Provider Enumeration Date:
02/29/2008

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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