Healthcare Provider Details

I. General information

NPI: 1194319087
Provider Name (Legal Business Name): EMANUEL YAAKOBOV FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10816 72ND AVE STE 2
FOREST HILLS NY
11375-5656
US

IV. Provider business mailing address

10326 68TH RD APT B56
FOREST HILLS NY
11375-3272
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number347362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: