Healthcare Provider Details

I. General information

NPI: 1649870528
Provider Name (Legal Business Name): DIANA YAKUBOVA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA YAKUBOVA NP

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 5TH AVE
NEW YORK NY
10011
US

IV. Provider business mailing address

200 TRENTON RD
BROWNS MILLS NJ
08015-1705
US

V. Phone/Fax

Practice location:
  • Phone: 347-707-7735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF406659-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309948
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: