The Youth Fountain

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

THE YOUTH FOUNTAIN

Doing business as

Youth Fountain

Practice address

501 Iron Bridge Rd
Suite 9
Freehold, NJ 07728-5304

Phone

(866) 514-0025

Fax

(732) 358-0524

NPI assigned

Sep 9, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Emil Shakov, MD

Title

Owner

Phone

(866) 514-0025

Specialties & licenses 1

Addresses

Other names 1

• Youth Fountain Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1598190506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 IRON BRIDGE RD",
            "address_2": "SUITE 9",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077285304",
            "telephone_number": "866-514-0025",
            "fax_number": "732-358-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 IRON BRIDGE RD",
            "address_2": "SUITE 9",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077285304",
            "telephone_number": "866-514-0025",
            "fax_number": "732-358-0524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE YOUTH FOUNTAIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-09",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "SHAKOV",
        "authorized_official_first_name": "EMIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "866-514-0025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Youth Fountain",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Eye Health Group of Freehold, LLC
• The Jewish Home for Rehabilitation and Nursing Inc.
• The Puzzle Place LLC
• The Speech Social
• The Women'S Psychotherapy Center
• The Youth Success Network - Communilink and Mho
• Louis Thompson, P.T.
• Nicholas Timo, PHARMD.
• Timothy J. Hayes, DC, PA
• Jennifer M Tinson, FNP

• Surgery Physician in Freehold, NJ
• Providers in Freehold, NJ by specialty
• Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.