Provider Demographics
NPI:1457370561
Name:YACOUB, MAKEEN KHALIL (MDFRCS)
Entity type:Individual
Prefix:
First Name:MAKEEN
Middle Name:KHALIL
Last Name:YACOUB
Suffix:
Gender:M
Credentials:MDFRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GRAND STREET
Mailing Address - Street 2:PO BOX 934
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990
Mailing Address - Country:US
Mailing Address - Phone:845-986-5121
Mailing Address - Fax:845-988-5131
Practice Address - Street 1:9 GRAND STREET
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990
Practice Address - Country:US
Practice Address - Phone:845-986-5121
Practice Address - Fax:845-988-5131
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152366207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP44374095OtherMULTIPEAN
NJ10576OtherAMERIGROUP
NJ37414OtherAETNA
NY4C1598OtherHEALTH NET
NY738828OtherUNITED HEALTHCARE
NY1000015413OtherAFFINITY
NY0034259OtherGHI
NY4531177OtherAETNA
NYP462464OtherOXFORD
NY14867OtherHUDSON HEALTH
NJ4531177OtherCIGNA
NY5358892010OtherCIGNA HMO
NY01055590Medicaid
NY5358892OtherCIGNA
NY3010366OtherAETNA HMO
NJF04747OtherHEALTH NET
NYPIRS27858POtherHIP
NY5358892OtherCIGNA
NY14867OtherHUDSON HEALTH