Provider Demographics
NPI:1992534275
Name:DAVIDOV, JAKOB
Entity type:Individual
Prefix:
First Name:JAKOB
Middle Name:
Last Name:DAVIDOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 E 22ND ST # 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2503
Mailing Address - Country:US
Mailing Address - Phone:917-891-1233
Mailing Address - Fax:
Practice Address - Street 1:9920 4TH AVE STE 111
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8328
Practice Address - Country:US
Practice Address - Phone:718-715-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies