Provider Demographics
NPI:1679070932
Name:ILYAGUYEV, BENEDIKT
Entity Type:Individual
Prefix:
First Name:BENEDIKT
Middle Name:
Last Name:ILYAGUYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2625
Mailing Address - Country:US
Mailing Address - Phone:718-571-2901
Mailing Address - Fax:
Practice Address - Street 1:ONE GUSTAVE L. LEVY PLACE
Practice Address - Street 2:FLOOR 12, 1620
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:847-338-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309818207P00000X
NY309818-01207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty