Healthcare Provider Details

I. General information

NPI: 1720198047
Provider Name (Legal Business Name): RYAN YOUNG P. A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL SUITE 3
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

45 READE PL SUITE 3
POUGHKEEPSIE NY
12601-3947
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-4086
  • Fax: 845-471-8296
Mailing address:
  • Phone: 845-471-4086
  • Fax: 845-471-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number007189
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: