Provider Demographics
NPI:1689824609
Name:YOUNG, ANTHONY FENNELL (NP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FENNELL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 ADAM CLAYTON POWELL JR BLVD APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3746
Mailing Address - Country:US
Mailing Address - Phone:770-843-9567
Mailing Address - Fax:
Practice Address - Street 1:927 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1924
Practice Address - Country:US
Practice Address - Phone:516-271-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2025-02-14
Deactivation Date:2024-10-03
Deactivation Code:
Reactivation Date:2025-02-14
Provider Licenses
StateLicense IDTaxonomies
GARN163001163W00000X
NYF311930-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse