Provider Demographics
NPI:1740416569
Name:ANKE OTT-YOUNG MEDICAL PC
Entity Type:Organization
Organization Name:ANKE OTT-YOUNG MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ANKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-423-6251
Mailing Address - Street 1:219 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-2223
Mailing Address - Country:US
Mailing Address - Phone:516-423-6251
Mailing Address - Fax:
Practice Address - Street 1:999 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-742-3404
Practice Address - Fax:203-549-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty