Provider Demographics
NPI:1851327092
Name:KLEYN, ILYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:KLEYN
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 1:699 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-7905
Mailing Address - Country:US
Mailing Address - Phone:347-689-8880
Mailing Address - Fax:212-571-5001
Practice Address - Street 1:225 BROADWAY STE 1420
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3771
Practice Address - Country:US
Practice Address - Phone:212-571-5000
Practice Address - Fax:212-571-5001
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY223AK1Medicare ID - Type Unspecified
NYH18461Medicare UPIN