Provider Demographics
NPI:1801495148
Name:YAKUBOV, RACHEL LIORA (RN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LIORA
Last Name:YAKUBOV
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 62ND DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1234
Mailing Address - Country:US
Mailing Address - Phone:917-617-2363
Mailing Address - Fax:
Practice Address - Street 1:12 N BROADWAY APT 2B
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-7064
Practice Address - Country:US
Practice Address - Phone:718-866-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY801871252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency