Provider Demographics
NPI:1558398859
Name:YOUNG, JILL (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4056 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4779
Mailing Address - Country:US
Mailing Address - Phone:609-528-9150
Mailing Address - Fax:609-528-9151
Practice Address - Street 1:4056 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4779
Practice Address - Country:US
Practice Address - Phone:609-528-9150
Practice Address - Fax:609-528-9151
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07994000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0108766Medicaid
I56312Medicare UPIN
NJ0108766Medicaid