Provider Demographics
NPI:1851739015
Name:YAKUBOV, GABRIEL (RPA-C)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15018 72ND DR
Mailing Address - Street 2:#2F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2678
Mailing Address - Country:US
Mailing Address - Phone:917-302-5478
Mailing Address - Fax:
Practice Address - Street 1:15018 72ND DR
Practice Address - Street 2:#2F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2678
Practice Address - Country:US
Practice Address - Phone:917-302-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014691-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPRS0194467292OtherTIRF REMS