Provider Demographics
NPI:1306851118
Name:YUABOV, BORIS G (DPM)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:G
Last Name:YUABOV
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9810 64TH AVE
Mailing Address - Street 2:STE GB
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2541
Mailing Address - Country:US
Mailing Address - Phone:718-896-4367
Mailing Address - Fax:718-606-9521
Practice Address - Street 1:9810 64TH AVE
Practice Address - Street 2:STE GB
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2541
Practice Address - Country:US
Practice Address - Phone:718-896-4367
Practice Address - Fax:718-606-9521
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005681213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPB6501Medicare ID - Type UnspecifiedBCBS MEDICARE PART B
NYU79458Medicare UPIN