Provider Demographics
NPI:1417091943
Name:MILOSLAVSKIY, ILYA (DDS)
Entity Type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:MILOSLAVSKIY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 AVENUE OF THE AMERICAS
Mailing Address - Street 2:APT. 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4445
Mailing Address - Country:US
Mailing Address - Phone:917-658-4575
Mailing Address - Fax:
Practice Address - Street 1:1130 140TH AVE NE STE 100B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-746-6090
Practice Address - Fax:425-747-9856
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604525801223P0700X
NY0522221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02771488Medicaid