Provider Demographics
NPI:1487708160
Name:YOUNG, MARK ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:13A MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1941
Mailing Address - Country:US
Mailing Address - Phone:973-726-7400
Mailing Address - Fax:973-726-7440
Practice Address - Street 1:13A MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1941
Practice Address - Country:US
Practice Address - Phone:973-726-7400
Practice Address - Fax:973-726-7440
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA1234300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122577SQSMedicare Oscar/Certification