Healthcare Provider Details

I. General information

NPI: 1639268881
Provider Name (Legal Business Name): PERLITA ISON YOUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST C/O FACULTY PRACTICE MANAGEMENT SUITE I-37 NORTH
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-6551
  • Fax:
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-945-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number216492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: