Healthcare Provider Details

I. General information

NPI: 1477508729
Provider Name (Legal Business Name): PAULA D YOUNG I M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 GRAND AVE SUITE 307
BALDWIN NY
11510-3164
US

IV. Provider business mailing address

2280 GRAND AVE SUITE 307
BALDWIN NY
11510-3164
US

V. Phone/Fax

Practice location:
  • Phone: 516-398-0029
  • Fax: 516-378-1045
Mailing address:
  • Phone: 516-398-0029
  • Fax: 516-378-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number178888
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01663161
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier2156275
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA
# 3
Identifier10779768
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCAQH
# 4
Identifier30L87
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBCBS
# 5
Identifier1423639
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITEDHEALTHCARE
# 6
IdentifierP1959239
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD
# 7
Identifier0007098316
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA LIFE INS CO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: