Healthcare Provider Details

I. General information

NPI: 1154212033
Provider Name (Legal Business Name): CHRISTINA YACUBICH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD
BRONX NY
10461-2301
US

IV. Provider business mailing address

56 REGENT CT
STAMFORD CT
06907-1423
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: