Healthcare Provider Details

I. General information

NPI: 1841631009
Provider Name (Legal Business Name): YULIYA BABABEKOVA O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 GREEN ACRES MALL STE 118
VALLEY STREAM NY
11581-1535
US

IV. Provider business mailing address

1088 GREEN ACRES MALL STE 118
VALLEY STREAM NY
11581-1535
US

V. Phone/Fax

Practice location:
  • Phone: 516-568-2010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV008036
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTUV008036-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV008036-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: