MEDICARE: YAEL GABRIELLE SUBAR-HACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	27636	FL
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME168024	FL

General Provider Information

NPI Number	:	1174019152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAEL GABRIELLE SUBAR-HACK MD

Provider Business Mailing Address
First Line	:	9960 NW 116TH WAY STE 13
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33178-1175
Country	:	US
Telephone Number	:	786-924-1311
Fax Number	:	786-924-1313

Provider Business Practice Location Address
First Line	:	9970 CENTRAL PARK BLVD N STE 207
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-2236
Country	:	US
Telephone Number	:	561-482-1027
Fax Number	:	561-482-1028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	01/06/2026

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