Provider Demographics
NPI:1326719733
Name:ILYAGU MEDICAL PC
Entity Type:Organization
Organization Name:ILYAGU MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-716-7107
Mailing Address - Street 1:MARK ILYAGU MEDICAL PC
Mailing Address - Street 2:221 SEABREEZE AVE, APT PH2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224
Mailing Address - Country:US
Mailing Address - Phone:717-716-7107
Mailing Address - Fax:
Practice Address - Street 1:MARK ILYAGU MEDICAL PC
Practice Address - Street 2:811 SOUTHERN BLVD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:347-326-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty