Provider Demographics
NPI:1932500451
Name:WARTENBERG, YAKOV (PHARMD)
Entity Type:Individual
Prefix:
First Name:YAKOV
Middle Name:
Last Name:WARTENBERG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAZEL PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1108
Mailing Address - Country:US
Mailing Address - Phone:516-581-6164
Mailing Address - Fax:
Practice Address - Street 1:2 HAZEL PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1108
Practice Address - Country:US
Practice Address - Phone:516-581-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist