Doctor Name: | MICHAEL YOUNG |
NPI Number: | 1073962676 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1791 Route 23b Leeds, NY - 124511546 |
Business Phone Number: | 5189650843 |
Business Fax Number: | |
Mailing Address: | 1791 Route 23b, LEEDS |
State: | NY |
Postal Code: | 124511546 |
Phone Number: | 5189650843 |
Fax Number: | |
NPI Enumeration Date: | 06/06/2016 |
NPI Last Update Date: | 06/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |