Basic Information
Provider Information | |||||||||
NPI: | 1437124666 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YOUNG | ||||||||
FirstName: | MARGARET | ||||||||
MiddleName: | RUTH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DERINGER | ||||||||
OtherFirstName: | MARGARET | ||||||||
OtherMiddleName: | YOUNG | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 78 PIONEER ST | ||||||||
Address2: |   | ||||||||
City: | COOPERSTOWN | ||||||||
State: | NY | ||||||||
PostalCode: | 133261236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6075472801 | ||||||||
FaxNumber: | 6075476782 | ||||||||
Practice Location | |||||||||
Address1: | 1 ATWELL RD | ||||||||
Address2: |   | ||||||||
City: | COOPERSTOWN | ||||||||
State: | NY | ||||||||
PostalCode: | 133261301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6075477980 | ||||||||
FaxNumber: | 6075476782 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/21/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 129707-1 | NY | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 01162445 | 05 | NY |   | MEDICAID |