Provider Demographics
NPI:1568776722
Name:AN, DO YOUNG
Entity Type:Individual
Prefix:MR
First Name:DO
Middle Name:YOUNG
Last Name:AN
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 1:50 W COLUMBIA AVE
Mailing Address - Street 2:1FL
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1004
Mailing Address - Country:US
Mailing Address - Phone:201-941-1172
Mailing Address - Fax:
Practice Address - Street 1:50 W COLUMBIA AVE
Practice Address - Street 2:1FL
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1004
Practice Address - Country:US
Practice Address - Phone:201-941-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00044800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist