Provider Demographics
NPI:1265484802
Name:SMUGLIN, IIYA
Entity Type:Individual
Prefix:
First Name:IIYA
Middle Name:
Last Name:SMUGLIN
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 1:392 BEDFORD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2415
Mailing Address - Country:US
Mailing Address - Phone:718-364-0100
Mailing Address - Fax:718-295-9220
Practice Address - Street 1:392 BEDFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2415
Practice Address - Country:US
Practice Address - Phone:718-364-0100
Practice Address - Fax:718-295-9220
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0276790Medicaid
NYH52781Medicare UPIN
NY0276790Medicaid