Provider Demographics
NPI:1093865628
Name:YOUNG, VANESSA JOAN (PT, MA, MPH)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JOAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT, MA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 W 118TH ST
Mailing Address - Street 2:1 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1015
Mailing Address - Country:US
Mailing Address - Phone:212-864-8931
Mailing Address - Fax:
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:MLK 3121
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-4423
Practice Address - Fax:212-939-4405
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist