Provider Demographics
NPI:1861550899
Name:YOUNGERMAN, JOSEPH K (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:K
Last Name:YOUNGERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3202
Mailing Address - Country:US
Mailing Address - Phone:718-549-0455
Mailing Address - Fax:718-239-3669
Practice Address - Street 1:4690 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3202
Practice Address - Country:US
Practice Address - Phone:718-549-0455
Practice Address - Fax:718-239-3669
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-1097632084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0088466OtherGHI
NY144439OtherVALUE OPTION PROVIDER
NY25398OtherVALUE BEHAVIORAL HEALTH
NYP2097558OtherOXFORD HEALTH PLAN