Provider Demographics
NPI:1275551574
Name:YOUNG, IRIS (PA)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 648
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-7586
Mailing Address - Fax:585-473-4861
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 648
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-7586
Practice Address - Fax:585-473-4861
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3034363A00000X
NY003034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR53515Medicare UPIN
NYPA0112Medicare PIN