Provider Demographics
NPI:1386702868
Name:YOUNGREN, KJELL ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:KJELL
Middle Name:ANDREW
Last Name:YOUNGREN
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 1:8 SADDLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1900
Mailing Address - Country:US
Mailing Address - Phone:973-889-0049
Mailing Address - Fax:973-889-0043
Practice Address - Street 1:8 SADDLE RD STE 204
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1900
Practice Address - Country:US
Practice Address - Phone:973-889-0049
Practice Address - Fax:973-889-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06467700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH46718Medicare UPIN
NJ089756Medicare ID - Type Unspecified