Provider Demographics
NPI:1578882031
Name:IOFIK, ILYA (EMT)
Entity Type:Individual
Prefix:MR
First Name:ILYA
Middle Name:
Last Name:IOFIK
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ESSEX LN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2038
Mailing Address - Country:US
Mailing Address - Phone:215-776-3224
Mailing Address - Fax:
Practice Address - Street 1:111 BUCK RD STE 200
Practice Address - Street 2:SUIT 6
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1552
Practice Address - Country:US
Practice Address - Phone:215-776-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport