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NPI Code Detail

MEDICARE: FADI YACOUB MD

MEDICARE: FADI YACOUB 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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RC0000XCardiovascular Disease Physician25MA11478600NJ
3207R00000XInternal Medicine Physician318838NY

General Provider Information

NPI Number : 1497216212
Entity Type Code : Individual
Provider Name (Legal Business Name) : FADI YACOUB MD
Provider Business Mailing Address
First Line : 450 CLARKSON AVE # 1262
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2012
Country : US
Telephone Number : 718-270-2030
Fax Number :
Provider Business Practice Location Address
First Line : 450 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2012
Country : US
Telephone Number : 718-270-2030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2019
Last Update Date : 04/07/2026

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