Provider Demographics
NPI:1952183980
Name:NISIMOV, YAKOV (NP)
Entity Type:Individual
Prefix:
First Name:YAKOV
Middle Name:
Last Name:NISIMOV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 150TH ST APT B26
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3877
Mailing Address - Country:US
Mailing Address - Phone:718-415-5494
Mailing Address - Fax:
Practice Address - Street 1:7925 150TH ST APT B26
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3877
Practice Address - Country:US
Practice Address - Phone:718-415-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily