Provider Demographics
NPI:1790927929
Name:YOUNG, JOHN GERALD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GERALD
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 1/2 EAST 74TH ST.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-472-1862
Mailing Address - Fax:212-472-3858
Practice Address - Street 1:16 1/2 EAST 74TH ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-472-1862
Practice Address - Fax:212-472-3858
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112345-12084B0002X
CT0173582084B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity Medicine