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General NPI Number Information
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NPI Number | 1497452288
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Entity Type | Individual
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Provider Name | JEFFREY E YOUNG PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1 RIVER PL PH P210
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City | NEW YORK
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State | NY
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Zip | 10036-4392
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Country | US
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Telephone | 845-592-8148
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Fax | 845-592-8947
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | POUGHQUAG
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State | NY
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Zip | 12570-0249
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Country | US
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Telephone | 845-592-8148
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Fax | 845-592-8947
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 009075-01
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License Number State | NY
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