Provider Demographics
NPI:1629281324
Name:YOUNG, YVONNE THERESA (RDE,CDN,BS)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:THERESA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDE,CDN,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2328
Mailing Address - Country:US
Mailing Address - Phone:516-429-9577
Mailing Address - Fax:
Practice Address - Street 1:185 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2328
Practice Address - Country:US
Practice Address - Phone:516-429-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005041133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education