Provider Demographics
NPI:1417944984
Name:YOUNG, RICHARD ASIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ASIS
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 1:10230 66TH ROAD
Mailing Address - Street 2:30H
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7623
Mailing Address - Country:US
Mailing Address - Phone:917-756-4908
Mailing Address - Fax:877-299-9287
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:ROOM H3-27
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-1501
Practice Address - Fax:718-334-5721
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2011992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7620317OtherAETNA PROVIDER ID
NY01987806Medicaid
NY04112Medicare ID - Type UnspecifiedGHI-MEDICARE
NY7620317OtherAETNA PROVIDER ID
NY04112Medicare ID - Type UnspecifiedGHI-MEDICARE
NY01987806Medicaid