Healthcare Provider Details

I. General information

NPI: 1780520155
Provider Name (Legal Business Name): DANIEL YAKUBOV FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 YELLOWSTONE BLVD APT 101
FOREST HILLS NY
11375-1534
US

IV. Provider business mailing address

6540 108TH ST APT 6B
FOREST HILLS NY
11375-2219
US

V. Phone/Fax

Practice location:
  • Phone: 718-305-1056
  • Fax:
Mailing address:
  • Phone: 347-288-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF358828-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: