Provider Demographics
NPI:1942253414
Name:BLOKH, ILYA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:A
Last Name:BLOKH
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 1:3319 KINGS HWY
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2638
Mailing Address - Country:US
Mailing Address - Phone:718-676-4067
Mailing Address - Fax:718-676-4068
Practice Address - Street 1:3319 KINGS HWY
Practice Address - Street 2:SUITE 1J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2638
Practice Address - Country:US
Practice Address - Phone:718-676-4067
Practice Address - Fax:718-676-4068
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043935207RH0003X
PAMD430769207RH0003X
NY228150207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1932164OtherHIGHMARK
PA50066305OtherCAPITAL BLUE CROSS
PA50066305OtherCAPITAL BLUE CROSS
PA108793Medicare PIN