Healthcare Provider Details

I. General information

NPI: 1790927929
Provider Name (Legal Business Name): JOHN GERALD YOUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 1/2 EAST 74TH ST.
NEW YORK NY
10021
US

IV. Provider business mailing address

16 1/2 EAST 74TH ST.
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-472-1862
  • Fax: 212-472-3858
Mailing address:
  • Phone: 212-472-1862
  • Fax: 212-472-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number112345-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number017358
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: