MEDICARE: ESTHER YAKUBOVA

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	1223P0221X	Pediatric Dentistry	064936	NY

General Provider Information

NPI Number	:	1174216030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER YAKUBOVA

Provider Business Mailing Address
First Line	:	1775 GRAND CONCOURSE FL 6
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-8202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 E BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-5503
Country	:	US
Telephone Number	:	718-901-8400
Fax Number	:

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

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	12/01/2025

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Directions to “ ESTHER YAKUBOVA ” Practice Location

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