Organization
THE YOUTH FOUNTAIN
Active
Other names
Youth Fountain
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMIL SHAKOV MD (OWNER)
(866) 514-0025
Entity
Organization
Contact information
Practice address
501 IRON BRIDGE RD, SUITE 9, FREEHOLD, NJ 07728-5304
(866) 514-0025
(732) 358-0524
Mailing address
501 IRON BRIDGE RD, SUITE 9, FREEHOLD, NJ 07728-5304
(866) 514-0025
(732) 358-0524
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
09/09/2013
Last updated
11/25/2014
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