Provider Demographics
NPI:1033681358
Name:YOUNG, JENNAE (MSED)
Entity Type:Individual
Prefix:
First Name:JENNAE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19418 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1132
Mailing Address - Country:US
Mailing Address - Phone:646-874-7839
Mailing Address - Fax:
Practice Address - Street 1:19418 109TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1132
Practice Address - Country:US
Practice Address - Phone:646-874-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1282998181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist