Healthcare Provider Details

I. General information

NPI: 1720174717
Provider Name (Legal Business Name): IVEN SHELDON YOUNG MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SEVENTH AVENUE 2ND FLOOR
NEW YORK CITY NY
10001
US

IV. Provider business mailing address

275 SEVENTH AVENUE 2ND FLOOR
NEW YORK CITY NY
10001
US

V. Phone/Fax

Practice location:
  • Phone: 212-356-4474
  • Fax: 212-356-4608
Mailing address:
  • Phone: 212-675-9332
  • Fax: 212-604-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number084132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: