Provider Demographics
NPI:1326014796
Name:YOUNG, LAWRENCE LOONGSANG (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:LOONGSANG
Last Name:YOUNG
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 1:19 BOWERY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6702
Mailing Address - Country:US
Mailing Address - Phone:347-237-7060
Mailing Address - Fax:212-625-8922
Practice Address - Street 1:19 BOWERY
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6702
Practice Address - Country:US
Practice Address - Phone:347-237-7060
Practice Address - Fax:212-625-8922
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113960207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00208402Medicaid
NY00208402Medicaid
NY965961Medicare PIN