Provider Demographics
NPI:1568536068
Name:ILIESCU, CONSTANTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTIN
Middle Name:
Last Name:ILIESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3117
Mailing Address - Country:US
Mailing Address - Phone:914-725-2564
Mailing Address - Fax:914-725-3192
Practice Address - Street 1:7019 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3922
Practice Address - Country:US
Practice Address - Phone:718-457-7955
Practice Address - Fax:718-457-7891
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119482207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00224144Medicaid
NYPIN 07178Medicare ID - Type Unspecified
NY00224144Medicaid