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General NPI Number Information
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NPI Number | 1205881109
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Entity Type | Organization
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Legal Business Name | ROGER YOUNG, PC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 2004 BAYSHORE RD
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City | VILLAS
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State | NJ
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Zip | 08251-1815
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Country | US
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Telephone | 609-886-1578
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Fax | 609-886-3520
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Provider Business Mailing Address
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Address Line | 2004 BAYSHORE RD
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City | VILLAS
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State | NJ
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Zip | 08251-1815
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Country | US
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Telephone | 609-886-1578
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Fax | 609-886-3520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER ALLEN YOUNG
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Credential | O.D.
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Telephone | 609-886-7156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 270A00383700
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License Number State | NJ
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