Provider Demographics
NPI:1467161349
Name:NY GASTROENTEROLOGY & LIVER DISEASE PC
Entity Type:Organization
Organization Name:NY GASTROENTEROLOGY & LIVER DISEASE PC
Other - Org Name:NY GASTROENTEROLOGY & LIVER DISEASE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-588-9800
Mailing Address - Street 1:9932 66TH RD STE LE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4405
Mailing Address - Country:US
Mailing Address - Phone:929-588-9800
Mailing Address - Fax:929-376-0856
Practice Address - Street 1:9932 66TH RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4462
Practice Address - Country:US
Practice Address - Phone:929-588-9800
Practice Address - Fax:929-376-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty