Healthcare Provider Details

I. General information

NPI: 1891751905
Provider Name (Legal Business Name): EDWARD F YOUNGHANS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FRANKLIN AVE SUITE 2
WYCKOFF NJ
07481-1909
US

IV. Provider business mailing address

350 FRANKLIN AVE SUITE 2
WYCKOFF NJ
07481-1909
US

V. Phone/Fax

Practice location:
  • Phone: 201-891-4930
  • Fax: 201-891-4715
Mailing address:
  • Phone: 201-891-4930
  • Fax: 201-891-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD001296
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: