Healthcare Provider Details

I. General information

NPI: 1568442648
Provider Name (Legal Business Name): K. GEORGE YOUNAN MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KIRVARKIS YALDA YOUNAN

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BORDENTOWN AVE STE #10
PARLIN NJ
08859
US

IV. Provider business mailing address

1145 BORDENTOWN AVE STE #10
PARLIN NJ
08859
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-0400
  • Fax: 732-727-1391
Mailing address:
  • Phone: 732-727-5376
  • Fax: 732-727-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29755
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: