Provider Demographics
NPI:1548469489
Name:YAKUBOVA, MARINA B (MD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:B
Last Name:YAKUBOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13827 82ND DR
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1127
Mailing Address - Country:US
Mailing Address - Phone:718-487-8009
Mailing Address - Fax:
Practice Address - Street 1:13827 82ND DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1127
Practice Address - Country:US
Practice Address - Phone:718-487-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008505-1363A00000X
390200000X
CT56949207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program