Provider Demographics
NPI:1053737320
Name:YOUNG, NAIJA (LPN)
Entity type:Individual
Prefix:
First Name:NAIJA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W MOSHOLU PKWY S
Mailing Address - Street 2:APT 25K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 W MOSHOLU PKWY S
Practice Address - Street 2:APT 25K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1126
Practice Address - Country:US
Practice Address - Phone:347-968-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310853164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse