Provider Demographics
NPI:1710360201
Name:ADVANT ORTHOCARE
Entity Type:Organization
Organization Name:ADVANT ORTHOCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-428-4600
Mailing Address - Street 1:5847 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1698
Mailing Address - Country:US
Mailing Address - Phone:718-428-4600
Mailing Address - Fax:718-428-4611
Practice Address - Street 1:5847 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1698
Practice Address - Country:US
Practice Address - Phone:718-428-4600
Practice Address - Fax:718-428-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2019021332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies