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General NPI Number Information
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NPI Number | 1639268881
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Entity Type | Individual
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Provider Name | PERLITA ISON YOUNG M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 374 STOCKHOLM ST C/O FACULTY PRACTICE MANAGEMENT SUITE I-37 NORTH
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City | BROOKLYN
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State | NY
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Zip | 11237-4006
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Country | US
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Telephone | 718-963-6551
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Fax |
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Provider Business Mailing Address
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Address Line | 6200 BEACH CHANNEL DR
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City | ARVERNE
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State | NY
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Zip | 11692-1409
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Country | US
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Telephone | 718-945-7150
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Fax | 718-945-2596
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 216492
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License Number State | NY
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