Provider Demographics
NPI:1558542381
Name:ILIONSKY, NATALIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:
Last Name:ILIONSKY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 E 23RD ST
Mailing Address - Street 2:APT#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2825
Mailing Address - Country:US
Mailing Address - Phone:718-368-1260
Mailing Address - Fax:
Practice Address - Street 1:2697 E 23RD ST
Practice Address - Street 2:APT#2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2825
Practice Address - Country:US
Practice Address - Phone:718-368-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011588363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical