Provider Demographics
NPI:1366696338
Name:BRYAN O'YOUNG, M.D., P.C.
Entity type:Organization
Organization Name:BRYAN O'YOUNG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-219-8885
Mailing Address - Street 1:265 CANAL ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-6010
Mailing Address - Country:US
Mailing Address - Phone:212-219-8885
Mailing Address - Fax:212-219-7527
Practice Address - Street 1:265 CANAL ST
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-6010
Practice Address - Country:US
Practice Address - Phone:212-219-8885
Practice Address - Fax:212-219-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA203035-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy