Healthcare Provider Details

I. General information

NPI: 1770405417
Provider Name (Legal Business Name): GABRIEL YAKUBOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14446 75TH AVE
FLUSHING NY
11367-2415
US

IV. Provider business mailing address

14446 75TH AVE
FLUSHING NY
11367-2415
US

V. Phone/Fax

Practice location:
  • Phone: 718-913-6529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358791-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: