Basic Information
| Provider Information | |||||||||
| NPI: | 1760400451 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | FAITH | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST | ||||||||
| Address2: | SW200 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | 8563826455 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 COOPER PLZ 400 HADDON AVENUE | ||||||||
| Address2: | SUITE 3200 | ||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556322667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 25MA00941700 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207R00000X | INTERNAL MEDICINE | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 177309 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | INTERNAL MEDICINE | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207RH0003X | 25MA09941700 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0000X | 177309 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 102763913 | 05 | PA | MEDICAID | 0310859 | 05 | NJ | MEDICAID |