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General NPI Number Information
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NPI Number | 1437392198
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Entity Type | Organization
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Legal Business Name | MID ATLANTIC DIABETES AND ENDOCRINOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 555 IRON BRIDGE RD STE 18
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City | FREEHOLD
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State | NJ
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Zip | 07728-2975
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Country | US
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Telephone | 732-409-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 555 IRON BRIDGE RD STE 18
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City | FREEHOLD
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State | NJ
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Zip | 07728-2975
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Country | US
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Telephone | 732-409-6233
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA YOUNG
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Credential | MD
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Telephone | 732-685-2747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MA72694
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License Number State | NJ
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