Healthcare Provider Details

I. General information

NPI: 1073055083
Provider Name (Legal Business Name): KAITLIN YOUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 HIGGINS AVE
BRIELLE NJ
08730-1480
US

IV. Provider business mailing address

143 HOLLYWOOD DR
BRICK NJ
08723-3388
US

V. Phone/Fax

Practice location:
  • Phone: 732-712-2300
  • Fax: 732-456-6700
Mailing address:
  • Phone: 718-483-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00417300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: