Healthcare Provider Details

I. General information

NPI: 1750651063
Provider Name (Legal Business Name): JAYNE YOUNG PROPERT APN-RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ALBANY RD
NEPTUNE NJ
07753-5201
US

IV. Provider business mailing address

29 ALBANY RD
NEPTUNE NJ
07753-5201
US

V. Phone/Fax

Practice location:
  • Phone: 732-682-6102
  • Fax:
Mailing address:
  • Phone: 732-682-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number26NR13479200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00425700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: