Basic Information
| Provider Information | |||||||||
| NPI: | 1568667392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE | ||||||||
| Address2: | BUILDING 1300 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096776060 | ||||||||
| FaxNumber: | 6096776061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE | ||||||||
| Address2: | BUILDING 1300 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096776060 | ||||||||
| FaxNumber: | 6096776061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 25MB07721400 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208VP0000X | 25MB07721400 | NJ | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.