Provider Demographics
NPI:1679554059
Name:YUNG, SHIRLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:YUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 GEORGE ST
Mailing Address - Street 2:ERIC B. CHANDLER HEALTH CLINIC
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1311
Mailing Address - Country:US
Mailing Address - Phone:732-235-6700
Mailing Address - Fax:732-235-8583
Practice Address - Street 1:277 GEORGE ST
Practice Address - Street 2:ERIC B. CHANDLER HEALTH CLINIC
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1311
Practice Address - Country:US
Practice Address - Phone:732-235-6700
Practice Address - Fax:732-235-8583
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168359-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C431220Medicaid
CAEU268ZMedicare PIN
CAWC43122FMedicare PIN
CA00C431220Medicaid