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General NPI Number Information
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NPI Number | 1144380981
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Entity Type | Individual
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Provider Name | YAKOV YAGUDAYEV MD
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8515 MAIN STREET
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City | BRIARWOOD
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State | NY
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Zip | 11435
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Country | US
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Telephone | 718-523-7186
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Fax | 718-523-3076
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Provider Business Mailing Address
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Address Line | 8240 217 STREET
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City | HOLLIS HILLS
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State | NY
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Zip | 11427
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Country | US
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Telephone | 718-146-8734
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Fax | 718-523-3076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 210754
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License Number State | NY
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