Basic Information
| Provider Information | |||||||||
| NPI: | 1710968730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | EUFROSINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 317 | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133460317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158246652 | ||||||||
| FaxNumber: | 3158246544 | ||||||||
| Practice Location | |||||||||
| Address1: | 164 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133469575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158244600 | ||||||||
| FaxNumber: | 3158248447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 237766 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 02138521 | 05 | NY | MEDICAID |