Individual provider Active NPI

Stanley Yakubov, M.D.

  • Gastroenterology Physician
  • Rego Park, NY
National Provider Identifier
1982993754
Registry record updated Dec 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
276349 Issued in NY
Practice address
9932 66TH Rd
Rego Park, NY 11374-4462
Phone
(929) 588-9800
Fax
(929) 376-0856
NPI assigned
Apr 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 276349 NY
Gastroenterology Physician 207RG0100X 276349 NY Primary

Addresses

Primary practice location

9932 66TH Rd
Rego Park, NY 11374-4462

Mailing address

9932 66TH Rd Ste Le
Rego Park, NY 11374-4405
Phone (929) 588-9800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141212001150 NY Practitioner - Internal Medicine 8527380922 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9932 66TH Rd
Suite Le
Rego Park, NY 11374-4405
Phone (929) 588-9800

Hospital & facility affiliations

  • Queens Hospital Center Hospital, Jamaica, NY, CCN 330231

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy17
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
276349NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maimonides Medical Center Maimonides Primary Care FPP Internal Medicine CurrentSince Aug 1, 2014 Accepting new patients
Maimonides Medical Center Current Accepting new patients
Maimonides Faculty Practice Plan Internal Medicine CurrentSince Aug 5, 2019 Accepting new patients
Ny Gastroenterology & Liver Disease PC Internal Medicine CurrentSince Aug 20, 2022 Accepting new patients
New York City Health and Hospitals Corporation Internal Medicine Past Accepting new patients
Susan Collura Schiliro DPT PT CHT PC PastSince Dec 31, 2023 Accepting new patients

Locations

4802 10th Ave
Brooklyn, NY 11219
Phone (718) 283-8724

17660 Union Tpke
Ste 101
Fresh Meadows, NY 11366
Phone (347) 738-5700

16110 Jamaica Ave
Jamaica, NY 11432
Phone (718) 674-1000

9932 66th Rd
Ste Le
Rego Park, NY 11374
Phone (718) 544-1937

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: stanleyyakubov@mai.allscriptsdirect.net
  • Direct secure messaging: syakubov1657211@nychhc.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1982993754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9932 66TH RD STE LE",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744405",
            "telephone_number": "929-588-9800",
            "fax_number": "929-376-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9932 66TH RD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744462",
            "telephone_number": "929-588-9800",
            "fax_number": "929-376-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAKUBOV",
        "first_name": "STANLEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-01",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "276349",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "276349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.