Healthcare Provider Details

I. General information

NPI: 1104265768
Provider Name (Legal Business Name): JAMES JACOB YOUNG MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE ANNENBERG BUILDING, 2ND FLOOR, EPILEPSY CENTER
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

1468 MADISON AVE ANNENBERG BUILDING, 2ND FLOOR, EPILEPSY CENTER
NEW YORK NY
10029-6508
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-2627
  • Fax: 516-939-1516
Mailing address:
  • Phone: 212-241-2627
  • Fax: 516-939-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number273386
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number273386
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: