Provider Demographics
NPI:1851300206
Name:YAKOBY, MILA (MD)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:
Last Name:YAKOBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 JOHNSON AVE
Mailing Address - Street 2:APT 20M
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4925
Mailing Address - Country:US
Mailing Address - Phone:718-581-0598
Mailing Address - Fax:
Practice Address - Street 1:2601 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7745
Practice Address - Country:US
Practice Address - Phone:718-616-4408
Practice Address - Fax:718-616-4105
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459947Medicaid
NY2590355OtherGHI
NYI00169Medicare UPIN
NY02459947Medicaid