Healthcare Provider Details

I. General information

NPI: 1427968767
Provider Name (Legal Business Name): JENNIFER YAQOOB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 THE PLZ
SCHENECTADY NY
12308-2639
US

IV. Provider business mailing address

1445 THE PLZ
SCHENECTADY NY
12308-2639
US

V. Phone/Fax

Practice location:
  • Phone: 518-881-2044
  • Fax: 518-370-8185
Mailing address:
  • Phone: 518-881-2044
  • Fax: 518-370-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number869408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: