Healthcare Provider Details

I. General information

NPI: 1205897949
Provider Name (Legal Business Name): ESTELLE IRENE YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 95TH ST
NEW YORK NY
10128-4077
US

IV. Provider business mailing address

PO BOX 20182
NEW YORK NY
10021-0063
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-8000
  • Fax: 212-484-3578
Mailing address:
  • Phone: 212-249-5948
  • Fax: 212-249-5948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number112482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: