Individual
YEVGENIY YAKUBOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
760 BROADWAY, BROOKLYN, NY 11206
(718) 963-8786
Mailing address
760 BROADWAY, BROOKLYN, NY 11206
(718) 963-8786
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
012162
NY
Other
Enumeration date
10/19/2007
Last updated
12/05/2022
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