Provider Demographics
NPI:1255498804
Name:JO, YOUNG (MD)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:
Last Name:JO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 UNION AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1272
Mailing Address - Country:US
Mailing Address - Phone:973-778-2665
Mailing Address - Fax:973-778-9753
Practice Address - Street 1:930 CLIFTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-778-2665
Practice Address - Fax:973-778-9753
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04060900207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3749509Medicaid
NJB19710Medicare UPIN
NJ3749509Medicaid