Provider Demographics
NPI:1124021423
Name:BAE, YOUNG C (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:C
Last Name:BAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1058
Mailing Address - Country:US
Mailing Address - Phone:732-240-0053
Mailing Address - Fax:732-240-9360
Practice Address - Street 1:512 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8021
Practice Address - Country:US
Practice Address - Phone:732-240-0053
Practice Address - Fax:732-240-9360
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075528002085R0001X
MDD00201142085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1743YCOtherMEDICARE#
NJP00336175OtherRAILROAD MEDICARE
MD52565Medicaid
WV0117936000Medicaid
NJ091899Medicare PIN
WV0117936000Medicaid