Provider Demographics
NPI:1922299882
Name:MITEV, ILIYA D (MD)
Entity Type:Individual
Prefix:MR
First Name:ILIYA
Middle Name:D
Last Name:MITEV
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 1:61 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-4001
Mailing Address - Country:US
Mailing Address - Phone:908-735-2594
Mailing Address - Fax:
Practice Address - Street 1:61 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-4001
Practice Address - Country:US
Practice Address - Phone:908-735-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08265600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169943Medicaid
NJ119463V6MMedicare PIN
NJ0169943Medicaid
NJ119463DF7Medicare PIN