Provider Demographics
NPI:1326229758
Name:HA, EUGENE YOUNG
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:YOUNG
Last Name:HA
Suffix:
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 1:20 MERRIVALE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1708
Mailing Address - Country:US
Mailing Address - Phone:917-843-8269
Mailing Address - Fax:
Practice Address - Street 1:3921 9TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3207
Practice Address - Country:US
Practice Address - Phone:718-435-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03870537Medicaid
NY03870537Medicaid