Provider Demographics
NPI:1073677225
Name:YOUNGWORTH, LYNDA ANN (MD, CM, PC)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:ANN
Last Name:YOUNGWORTH
Suffix:
Gender:F
Credentials:MD, CM, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1255 BROAD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3061
Mailing Address - Country:US
Mailing Address - Phone:973-707-7057
Mailing Address - Fax:866-806-3675
Practice Address - Street 1:615 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1746
Practice Address - Country:US
Practice Address - Phone:973-857-2000
Practice Address - Fax:973-857-7036
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46091207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1306580002Medicare UPIN
NJ455125Medicare ID - Type Unspecified