Provider Demographics
NPI:1538602735
Name:YAKOUBIAN, ANAIT
Entity type:Individual
Prefix:
First Name:ANAIT
Middle Name:
Last Name:YAKOUBIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 SHALER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2533
Mailing Address - Country:US
Mailing Address - Phone:201-840-9497
Mailing Address - Fax:
Practice Address - Street 1:396 SHALER BLVD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2533
Practice Address - Country:US
Practice Address - Phone:201-840-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00672300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse