Healthcare Provider Details

I. General information

NPI: 1508761727
Provider Name (Legal Business Name): YAKOV CHAIM ISRAILOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 N SALISBURY BLVD STE 1056
SALISBURY MD
21801-2141
US

IV. Provider business mailing address

6518 GARDENWICK RD
BALTIMORE MD
21209-2538
US

V. Phone/Fax

Practice location:
  • Phone: 667-400-5698
  • Fax:
Mailing address:
  • Phone: 667-400-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: