Provider Demographics
NPI:1598153983
Name:YAKUBOV, ABO
Entity Type:Individual
Prefix:
First Name:ABO
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14419 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2401
Mailing Address - Country:US
Mailing Address - Phone:646-464-2025
Mailing Address - Fax:
Practice Address - Street 1:14419 72ND AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2401
Practice Address - Country:US
Practice Address - Phone:646-464-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist