Healthcare Provider Details

I. General information

NPI: 1609220763
Provider Name (Legal Business Name): ARI SAMUEL YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK RD STE 210
SUMMIT NJ
07901-3562
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 646
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5040
  • Fax: 908-522-5041
Mailing address:
  • Phone: 585-275-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA11404000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: