Provider Demographics
NPI:1891751905
Name:YOUNGHANS, EDWARD F (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:YOUNGHANS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FRANKLIN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1909
Mailing Address - Country:US
Mailing Address - Phone:201-891-4930
Mailing Address - Fax:201-891-4715
Practice Address - Street 1:350 FRANKLIN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1909
Practice Address - Country:US
Practice Address - Phone:201-891-4930
Practice Address - Fax:201-891-4715
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001296213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1618300Medicaid
NJT44552Medicare UPIN
NJ1618300Medicaid
NJ6305910001Medicare NSC