Provider Demographics
NPI:1326223777
Name:YOUNGHANS, RAYMOND M (PT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:M
Last Name:YOUNGHANS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-488-0488
Mailing Address - Fax:845-858-9998
Practice Address - Street 1:136 HOPPER AVENUE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463
Practice Address - Country:US
Practice Address - Phone:201-493-7770
Practice Address - Fax:845-858-9998
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029997225100000X
NJ40QA01412200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5676Q34W1Medicare PIN