Basic Information
| Provider Information | |||||||||
| NPI: | 1659528206 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YOUNG | ||||||||
| FirstName: | SUSAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1014 | ||||||||
| Address2: | 1180 RARITAN ROAD | ||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328559751 | ||||||||
| FaxNumber: | 7328559755 | ||||||||
| Practice Location | |||||||||
| Address1: | 2625 MORRIS AVE | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070835665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086860840 | ||||||||
| FaxNumber: | 9086269250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 10/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00352500 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.