Provider Demographics
NPI:1033251947
Name:J.Y. PROFESSIONAL RADIOLOGY PC
Entity Type:Organization
Organization Name:J.Y. PROFESSIONAL RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHANGUIR
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGHOOBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-921-9747
Mailing Address - Street 1:PO BOX 90422
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-0422
Mailing Address - Country:US
Mailing Address - Phone:718-921-9747
Mailing Address - Fax:
Practice Address - Street 1:699 92ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3619
Practice Address - Country:US
Practice Address - Phone:718-567-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01131199Medicaid
NYW17551Medicare PIN