Provider Demographics
NPI:1962586610
Name:KIVARKIS Y YOUNAN MD PA
Entity type:Organization
Organization Name:KIVARKIS Y YOUNAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KIVARKIS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YOUNAN MD PA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-727-0400
Mailing Address - Street 1:1145 BORDENTOWN AVE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859
Mailing Address - Country:US
Mailing Address - Phone:732-727-0400
Mailing Address - Fax:732-727-1391
Practice Address - Street 1:1145 BORDENTOWN AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859
Practice Address - Country:US
Practice Address - Phone:732-727-0400
Practice Address - Fax:732-727-1391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty