Healthcare Provider Details

I. General information

NPI: 1568966810
Provider Name (Legal Business Name): IRINI YACOUB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRINI YOUSSEF MD

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E 126TH ST
NEW YORK NY
10035-1406
US

IV. Provider business mailing address

225 E 126TH ST
NEW YORK NY
10035-1406
US

V. Phone/Fax

Practice location:
  • Phone: 833-697-7686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number321119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: