Provider Demographics
NPI:1528490026
Name:LEV YAGUDAYEV PHYSICIAN, PC
Entity type:Organization
Organization Name:LEV YAGUDAYEV PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-686-5073
Mailing Address - Street 1:7585 181ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1609
Mailing Address - Country:US
Mailing Address - Phone:917-686-5073
Mailing Address - Fax:718-236-1055
Practice Address - Street 1:14445 87TH AVE
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-3109
Practice Address - Country:US
Practice Address - Phone:917-686-5073
Practice Address - Fax:718-236-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty