Provider Demographics
NPI:1922853464
Name:ILYAEV MEDICINE PLLC
Entity Type:Organization
Organization Name:ILYAEV MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-255-9955
Mailing Address - Street 1:1659 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3317
Mailing Address - Country:US
Mailing Address - Phone:718-255-9955
Mailing Address - Fax:
Practice Address - Street 1:1659 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3317
Practice Address - Country:US
Practice Address - Phone:718-255-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty