Provider Demographics
NPI:1083016828
Name:SAPOZHNIK, ILYA
Entity Type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:SAPOZHNIK
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 1:49 BOKEE CT APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6166
Mailing Address - Country:US
Mailing Address - Phone:718-450-7242
Mailing Address - Fax:
Practice Address - Street 1:49 BOKEE CT APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6166
Practice Address - Country:US
Practice Address - Phone:718-450-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist