Provider Demographics
NPI:1942260344
Name:YAGUDIN, YURIY (DO)
Entity type:Individual
Prefix:DR
First Name:YURIY
Middle Name:
Last Name:YAGUDIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 MADISON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1131
Mailing Address - Country:US
Mailing Address - Phone:212-223-2235
Mailing Address - Fax:
Practice Address - Street 1:422 MADISON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1131
Practice Address - Country:US
Practice Address - Phone:212-223-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223803174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02395935Medicaid
NY02395935Medicaid
NYI30AS1Medicare ID - Type Unspecified