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General NPI Number Information
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NPI Number | 1518627512
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Entity Type | Organization
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Legal Business Name | RAFAEL YAAKOBOV FAMILY HEALTH NP PC
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Dates
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Enumeration Date | 12/19/2021
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Last Update Date | 12/19/2021
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Provider Practice Location Address
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Address Line | 6405 YELLOWSTONE BLVD STE CF104
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City | FOREST HILLS
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State | NY
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Zip | 11375-1588
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Country | US
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Telephone | 347-836-3045
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Fax |
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Provider Business Mailing Address
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Address Line | 6405 YELLOWSTONE BLVD STE CF104
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City | FOREST HILLS
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State | NY
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Zip | 11375-1588
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Country | US
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Telephone | 347-836-3045
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAFAEL YAAKOBOV
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Credential | NP
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Telephone | 347-836-3045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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