Provider Demographics
NPI:1003174962
Name:YOUNG, NINA LOUISE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:LOUISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PENNINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1414
Mailing Address - Country:US
Mailing Address - Phone:845-354-5226
Mailing Address - Fax:845-354-8583
Practice Address - Street 1:1 FORDHAM PLZ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5871
Practice Address - Country:US
Practice Address - Phone:718-329-8109
Practice Address - Fax:718-741-7928
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62-015026171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY62-015026OtherNYS LICENSE NUMBER