Provider Demographics
NPI:1235614603
Name:YOUNG, BERNIS AKEEM JR
Entity Type:Individual
Prefix:
First Name:BERNIS
Middle Name:AKEEM
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FLATBUSH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1101
Mailing Address - Country:US
Mailing Address - Phone:718-852-2584
Mailing Address - Fax:
Practice Address - Street 1:25 FLATBUSH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1101
Practice Address - Country:US
Practice Address - Phone:718-852-2584
Practice Address - Fax:718-285-8610
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYPCS-2546175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist