NPIMap

Organization Active NPI

David Yakobashvili,MD,LLC

  • Internal Medicine Physician
  • Chester, NJ
National Provider Identifier
1306097548
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DAVID YAKOBASHVILI,MD,LLC
Practice address
201 Pleasant Hill Rd
Chester, NJ 07930-2141
Phone
(917) 596-4004
NPI assigned
Oct 7, 2008
Last updated
Jun 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Yakobashvili, MDNPI 1265420137
Title
Owner
Phone
(917) 596-4004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

201 Pleasant Hill Rd
Chester, NJ 07930-2141

Mailing address

43 Westmount Dr
Livingston, NJ 07039-4230
Phone (917) 596-4004

Other practice location 1

758 Route 18 Ste 103A
East Brunswick, NJ 08816-4923
Phone (732) 360-9996

Other identifiers 1

IdentifierTypeStateIssuer
7625201MedicaidNJ

Other names 1

  • David Yakobashvili,MD,Limited Liability Company Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090713000178 NJ Part B Supplier - Clinic/Group Practice 1052460854 Receives reassigned benefits from 17 practitioners
Practice locations: Chester, NJ; West Orange, NJ

National Provider Directory

National Provider Directory

Locations

1199 Pleasant Valley Way
West Orange, NJ 07052
Phone (973) 414-4755

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1306097548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WESTMOUNT DR",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394230",
            "telephone_number": "917-596-4004",
            "fax_number": "973-369-7905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PLEASANT HILL RD",
            "city": "CHESTER",
            "state": "NJ",
            "postal_code": "079302141",
            "telephone_number": "917-596-4004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "758 Route 18 Ste 103A",
            "address_purpose": "LOCATION",
            "city": "East Brunswick",
            "state": "NJ",
            "postal_code": "088164923",
            "country_code": "US",
            "telephone_number": "732-360-9996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DAVID YAKOBASHVILI,MD,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "YAKOBASHVILI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-596-4004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7625201",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "David Yakobashvili,MD,Limited Liability Company",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chester, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.