Provider Demographics
NPI:1952441420
Name:IYAR MEDICAL PC
Entity Type:Organization
Organization Name:IYAR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGODUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-849-4917
Mailing Address - Street 1:7235 112TH ST
Mailing Address - Street 2:SUITE # PR9,
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5469
Mailing Address - Country:US
Mailing Address - Phone:877-849-4917
Mailing Address - Fax:877-949-4917
Practice Address - Street 1:7235 112TH ST
Practice Address - Street 2:SUITE # PR9,
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5469
Practice Address - Country:US
Practice Address - Phone:877-849-4917
Practice Address - Fax:877-949-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233906207R00000X
NY030904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000399390201OtherHEALTHPLUS
NY179953OtherELDERPLAN
NY268SV1OtherEMPIRE BLUE CROSS AND BLU
NYP3725574OtherOXFORD
NYPCP ID# 5416260001OtherCIGNA
NY02619565Medicaid
NY000000119919OtherGHI HMO
NY00002513975 09OtherUNITED HEALTHCARE
NY11P12182OtherNY PRESBYTERIAN
NY233906OtherHIP
NY6C5025OtherHEALTHNET
NY=========OtherMULTIPLAN
NY00002513975 09OtherUNITED HEALTHCARE
NY233906OtherHIP
NYPCP ID# 5416260001OtherCIGNA
NY000399390201OtherHEALTHPLUS
NY=========OtherMULTIPLAN
NYI21606Medicare UPIN