=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093865628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA JOAN YOUNG PT, MA, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 506 MALCOLM X BLVD MLK 3121
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-939-4423
-----------------------------------------------------
Fax | 212-939-4405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 370 W 118TH ST 1 B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10026-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-864-8931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 012448
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------