Provider Demographics
NPI:1992034961
Name:ISMAILOFF, KAMILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMILLA
Middle Name:
Last Name:ISMAILOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 111TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2415
Mailing Address - Country:US
Mailing Address - Phone:718-323-6588
Mailing Address - Fax:718-732-1893
Practice Address - Street 1:10423 111TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2415
Practice Address - Country:US
Practice Address - Phone:718-323-6588
Practice Address - Fax:718-732-1893
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263577208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist