Active NPI
Paul Young I
- Behavior Technician
- Port Jefferson Station, NY
National Provider Identifier
1265979702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 106S00000X
- Practice address
- 7 Atlantic Ave
Port Jefferson Station, NY 11776-2107 - Phone
- (631) 804-9007
- NPI assigned
- Jan 23, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 106S00000X | NY | Primary |
Addresses
Primary practice location
7 Atlantic Ave
Port Jefferson Station, NY 11776-2107
Mailing address
7 Atlantic Ave
Port Jefferson Station, NY 11776-2107
Phone (631) 804-9007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106S00000X | NY | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485129600000",
"number": "1265979702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 ATLANTIC AVE",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117762107",
"telephone_number": "631-804-9007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 ATLANTIC AVE",
"city": "PORT JEFFERSON STATION",
"state": "NY",
"postal_code": "117762107",
"telephone_number": "631-804-9007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "PAUL",
"name_prefix": "Mr.",
"name_suffix": "I",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-23",
"last_updated": "2017-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NY",
"license": "106S00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson Station, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.