Basic Information
| Provider Information | |||||||||
| NPI: | 1669505970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | RUPERTO | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 130 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121100130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187861291 | ||||||||
| FaxNumber: | 5187861293 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 GUY PARK AVE | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120101054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188417203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2085R0202X | 112147 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.