Basic Information
| Provider Information | |||||||||
| NPI: | 1720174717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | IVEN | ||||||||
| MiddleName: | SHELDON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 SEVENTH AVENUE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126759332 | ||||||||
| FaxNumber: | 2126043844 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 SEVENTH AVENUE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123564474 | ||||||||
| FaxNumber: | 2123564608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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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 | 207RE0101X | 084132 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 00126256 | 05 | NY | MEDICAID |