Provider Demographics
NPI:1194011171
Name:ILYA MILOSLAVSKIY DDS PLLC
Entity Type:Organization
Organization Name:ILYA MILOSLAVSKIY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILOSLAVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-658-4575
Mailing Address - Street 1:2364 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3640
Mailing Address - Country:US
Mailing Address - Phone:917-658-4575
Mailing Address - Fax:
Practice Address - Street 1:2364 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3640
Practice Address - Country:US
Practice Address - Phone:917-658-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02771488Medicaid