1043725708 NPI number — INESSA YAGUDAYEV OD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043725708 NPI number — INESSA YAGUDAYEV OD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INESSA YAGUDAYEV OD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043725708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2350 WATERS EDGE DRIVE
Provider Second Line Business Mailing Address:
APT 5I
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11156 76TH DR UPPR LOBBY2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-7057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-605-1828
Provider Business Practice Location Address Fax Number:
718-832-5326
Provider Enumeration Date:
12/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
YAGUDAYEV
Authorized Official First Name:
INESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
347-605-1828

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com