Provider Demographics
NPI:1689853061
Name:TATO, YOUNG H (PA)
Entity Type:Individual
Prefix:MS
First Name:YOUNG
Middle Name:H
Last Name:TATO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:YOUNG
Other - Middle Name:H
Other - Last Name:TATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:32 WARDMAN RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2728
Mailing Address - Country:US
Mailing Address - Phone:716-570-1175
Mailing Address - Fax:716-882-6430
Practice Address - Street 1:32 WARDMAN RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2728
Practice Address - Country:US
Practice Address - Phone:716-570-1175
Practice Address - Fax:716-882-6430
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009660363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009660OtherLICENSE
NY0995449OtherDEA