Provider Demographics
NPI:1538580287
Name:YAKUBOV, ROMAN
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROMAN
Other - Middle Name:
Other - Last Name:YAKUBOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIVERY TAXI
Mailing Address - Street 1:2526 50TH ST STE 206D
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7836
Mailing Address - Country:US
Mailing Address - Phone:718-545-7555
Mailing Address - Fax:718-545-7556
Practice Address - Street 1:2526 50TH ST STE 206D
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7836
Practice Address - Country:US
Practice Address - Phone:718-545-7555
Practice Address - Fax:718-545-7556
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-25
Last Update Date:2013-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB02674344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi