Provider Demographics
NPI:1144380981
Name:YAGUDAYEV, YAKOV (MD)
Entity type:Individual
Prefix:
First Name:YAKOV
Middle Name:
Last Name:YAGUDAYEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 217 STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLIS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11427
Mailing Address - Country:US
Mailing Address - Phone:718-146-8734
Mailing Address - Fax:718-523-3076
Practice Address - Street 1:8515 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:718-523-7186
Practice Address - Fax:718-523-3076
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02093965Medicaid
NYG96277Medicare UPIN
NY02093965Medicaid