Provider Demographics
NPI:1174809974
Name:BURSTEIN, YAKOV (PHD)
Entity type:Individual
Prefix:
First Name:YAKOV
Middle Name:
Last Name:BURSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18463 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1515
Mailing Address - Country:US
Mailing Address - Phone:718-380-2032
Mailing Address - Fax:
Practice Address - Street 1:18463 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1515
Practice Address - Country:US
Practice Address - Phone:718-380-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist