Provider Demographics
NPI:1073780763
Name:YOUNG, CHAINLLIE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAINLLIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WALKER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4135
Mailing Address - Country:US
Mailing Address - Phone:212-226-8866
Mailing Address - Fax:122-262-2289
Practice Address - Street 1:131-72 40TH ROAD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-886-7373
Practice Address - Fax:718-661-6035
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2638952084P0800X
NY2587472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03674224Medicaid