MEDICARE: IY NP IN ADULT HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1750222865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IY NP IN ADULT HEALTH PC

Provider Business Mailing Address
First Line	:	2324 E 74TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 E 74TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6626
Country	:	US
Telephone Number	:	917-443-4411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IOSIF YAKUBOV
Credential	:
Telephone Number	:	917-443-4411

Provider Enumeration Date	:	04/02/2026
Last Update Date	:	04/02/2026

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