Provider Demographics
NPI:1942089891
Name:ILYAYEVA IRINA PEDIATRICS PC
Entity Type:Organization
Organization Name:ILYAYEVA IRINA PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-595-9046
Mailing Address - Street 1:6391 ALDERTON ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3941
Mailing Address - Country:US
Mailing Address - Phone:917-595-9046
Mailing Address - Fax:
Practice Address - Street 1:3703 92ND ST FL 1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7929
Practice Address - Country:US
Practice Address - Phone:917-832-6562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty