Provider Demographics
NPI:1891792909
Name:O'YOUNG, BRYAN J (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:O'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 1:4602 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1317
Mailing Address - Country:US
Mailing Address - Phone:347-763-1091
Mailing Address - Fax:347-763-1092
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA203035-12081P2900X
PAMD4543952081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793177Medicaid
NY285818Medicare UPIN
NY100145761001Medicare UPIN
NY01793177Medicaid
NY203035-B31Medicare UPIN
NYP423912Medicare UPIN
NYOMO834Medicare UPIN
NY2799938Medicare UPIN
NY148460101Medicare UPIN
NY5300134Medicare UPIN
NY94E252Medicare PIN