Provider Demographics
NPI:1700669553
Name:YOUNGMAN, NATASHA HELENE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:HELENE
Last Name:YOUNGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2164 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3960
Mailing Address - Country:US
Mailing Address - Phone:707-572-4476
Mailing Address - Fax:
Practice Address - Street 1:2164 HUDSON AVE
Practice Address - Street 2:ROCHESTER, NY 14617
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3960
Practice Address - Country:US
Practice Address - Phone:707-572-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028625-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist