Provider Demographics
NPI:1720198047
Name:YOUNG, RYAN (P A)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-471-4086
Mailing Address - Fax:845-471-8296
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:SUITE 3
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-471-4086
Practice Address - Fax:845-471-8296
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007189207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY324027OtherMVP
NY0F555BW391Medicare ID - Type UnspecifiedMEDICARE
NY324027OtherMVP