Basic Information
| Provider Information | |||||||||
| NPI: | 1346636081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YACOUB | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 PARK PL STE 1200 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100072823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122267666 | ||||||||
| FaxNumber: | 9298889562 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100070029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122267666 | ||||||||
| FaxNumber: | 2122027988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2015 | ||||||||
| LastUpdateDate: | 02/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 292217 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.