Provider Demographics
NPI:1427375161
Name:ILIYA, YASMINE AFIF (LCAT)
Entity Type:Individual
Prefix:
First Name:YASMINE
Middle Name:AFIF
Last Name:ILIYA
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ATLANTIC AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6088
Mailing Address - Country:US
Mailing Address - Phone:631-974-0971
Mailing Address - Fax:
Practice Address - Street 1:200 ATLANTIC AVE
Practice Address - Street 2:APT 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6088
Practice Address - Country:US
Practice Address - Phone:631-974-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001344-1225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist