Healthcare Provider Details

I. General information

NPI: 1184858458
Provider Name (Legal Business Name): PAUL RAYMOND YOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 N BAILEY AVE SUITE 202
AMHERST NY
14226-1206
US

IV. Provider business mailing address

4955 N BAILEY AVE STE 202
AMHERST NY
14226-1206
US

V. Phone/Fax

Practice location:
  • Phone: 716-832-8500
  • Fax: 716-832-8501
Mailing address:
  • Phone: 716-832-8500
  • Fax: 716-832-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number268372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: