Provider Demographics
NPI:1639576564
Name:BRIARWOOD MEDICAL PC
Entity Type:Organization
Organization Name:BRIARWOOD MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-523-7188
Mailing Address - Street 1:8515 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1879
Mailing Address - Country:US
Mailing Address - Phone:718-523-7188
Mailing Address - Fax:718-523-5295
Practice Address - Street 1:8515 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:718-523-7188
Practice Address - Fax:718-523-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381653261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care