NPIMap

Individual provider Active NPI

Yakov Fattakhov

  • Pharmacist
  • Brooklyn, NY
National Provider Identifier
1972936979
Registry record updated Aug 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
057456 Issued in NY
Practice address
1454 Myrtle Ave
Brooklyn, NY 11237-5102
Phone
(718) 453-6200
NPI assigned
Aug 13, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 057456 NY Primary

Addresses

Primary practice location

1454 Myrtle Ave
Brooklyn, NY 11237-5102

Mailing address

1454 Myrtle Ave
Brooklyn, NY 11237-5102
Phone (718) 453-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
057456NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
V.G.H. Pharmacy Inc. Past Accepting new patients
Myrtle RX LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376352000000",
    "number": "1972936979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 MYRTLE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112375102",
            "telephone_number": "718-453-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 MYRTLE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112375102",
            "telephone_number": "718-453-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATTAKHOV",
        "first_name": "YAKOV",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "057456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.