Provider Demographics
NPI:1639373194
Name:ILYA LANTSBERG MD PC
Entity Type:Organization
Organization Name:ILYA LANTSBERG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANTSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-809-1630
Mailing Address - Street 1:2750 W 33RD ST
Mailing Address - Street 2:APT 1147
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1645
Mailing Address - Country:US
Mailing Address - Phone:718-809-1630
Mailing Address - Fax:
Practice Address - Street 1:2750 W 33RD ST
Practice Address - Street 2:APT 1147
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1645
Practice Address - Country:US
Practice Address - Phone:718-809-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty