Healthcare Provider Details

I. General information

NPI: 1730117938
Provider Name (Legal Business Name): JENNIFER L YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 E MAIN ST
BRANFORD CT
06405-2918
US

IV. Provider business mailing address

25 PAPER MILL DR
MADISON CT
06443-1908
US

V. Phone/Fax

Practice location:
  • Phone: 203-481-7008
  • Fax: 203-315-2712
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037361
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: