Healthcare Provider Details

I. General information

NPI: 1174019152
Provider Name (Legal Business Name): YAEL GABRIELLE SUBAR-HACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N STE 207
BOCA RATON FL
33428-2236
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 561-452-1027
  • Fax: 561-482-1028
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME168024
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: