Provider Demographics
NPI:1578282547
Name:YOUNG, CASSANDRA ELAINE (MSOT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ELAINE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E 14TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4226
Mailing Address - Country:US
Mailing Address - Phone:484-597-6446
Mailing Address - Fax:
Practice Address - Street 1:250 RIVER ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7514
Practice Address - Country:US
Practice Address - Phone:201-992-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01078500225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand