Healthcare Provider Details

I. General information

NPI: 1699962464
Provider Name (Legal Business Name): KJELL A. YOUNGREN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MADISON AVE BLDG. 5
MORRISTOWN NJ
07960-7400
US

IV. Provider business mailing address

PO BOX 600
FLORHAM PARK NJ
07932-0600
US

V. Phone/Fax

Practice location:
  • Phone: 973-889-0049
  • Fax: 973-889-0043
Mailing address:
  • Phone: 973-889-0049
  • Fax: 973-889-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMA06467700
License Number StateNJ

VIII. Authorized Official

Name: DR. KJELL ANDREW YOUNGREN
Title or Position: PHYSICIAN/CEO
Credential: M.D.
Phone: 973-889-0049