Basic Information
| Provider Information | |||||||||
| NPI: | 1326223777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNGHANS | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014880488 | ||||||||
| FaxNumber: | 8458589998 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 HOPPER AVENUE | ||||||||
| Address2: | |||||||||
| City: | WALDWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014937770 | ||||||||
| FaxNumber: | 8458589998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2008 | ||||||||
| LastUpdateDate: | 04/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 029997 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 40QA01412200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.