Healthcare Provider Details

I. General information

NPI: 1093570137
Provider Name (Legal Business Name): BEN YEUNG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 07/23/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 HURFFVILLE CROSSKEYS RD
SEWELL NJ
08080-2321
US

IV. Provider business mailing address

400 CEDAR AVE
WEST LONG BRANCH NJ
07764-1804
US

V. Phone/Fax

Practice location:
  • Phone: 856-219-0999
  • Fax: 856-582-9667
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: