Healthcare Provider Details

I. General information

NPI: 1821381195
Provider Name (Legal Business Name): YAKOV ASHEROV M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-15 164TH STREET
JAMAICA NY
11432-1118
US

IV. Provider business mailing address

8115 164TH ST
JAMAICA NY
11432-1118
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-3000
  • Fax: 718-969-6177
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: