Provider Demographics
NPI:1033162854
Name:YOUNG-AJOSE, DENISE M (MD, MPH)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:YOUNG-AJOSE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 BROADWAY PH
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2614
Mailing Address - Country:US
Mailing Address - Phone:347-943-8131
Mailing Address - Fax:
Practice Address - Street 1:632 BROADWAY PH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2614
Practice Address - Country:US
Practice Address - Phone:347-943-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08025500207Q00000X
HIMD-14650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2673709OtherUNITED HEALTHCARE
3K6389OtherHEALTH NET
4865P1OtherEMPIRE BC/BS NY
P3755509OtherOXFORD
0725268OtherCIGNA
1454540OtherAETNA
HI0000278218OtherHMSA BILLING NUMBER
NJ0106992Medicaid
HI622565-02Medicaid
HI622565-02Medicaid
NJ0106992Medicaid
101768DCHMedicare PIN