Provider Demographics
NPI:1225260706
Name:ABDENOUR YOUNG, SUSAN VICTORIA (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VICTORIA
Last Name:ABDENOUR YOUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 SHORE RD
Mailing Address - Street 2:APT 504
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6155
Mailing Address - Country:US
Mailing Address - Phone:718-921-0840
Mailing Address - Fax:
Practice Address - Street 1:9101 SHORE RD
Practice Address - Street 2:APT 504
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6155
Practice Address - Country:US
Practice Address - Phone:718-921-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004486-1152W00000X
NJ27OA00434200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist