Provider Demographics
NPI:1437336427
Name:YOUNG, GARY B (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234 N CENTRAL AVE
Mailing Address - Street 2:ROOM 204
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1809
Mailing Address - Country:US
Mailing Address - Phone:914-683-1777
Mailing Address - Fax:914-683-8951
Practice Address - Street 1:234 N CENTRAL AVE
Practice Address - Street 2:ROOM 204
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1809
Practice Address - Country:US
Practice Address - Phone:914-683-1777
Practice Address - Fax:914-683-8951
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC03307-8111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX20881Medicare PIN