Provider Demographics
NPI:1457060170
Name:ILAN SEMANDOV DO PC
Entity Type:Organization
Organization Name:ILAN SEMANDOV DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMANDOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-238-7234
Mailing Address - Street 1:1844 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2426
Mailing Address - Country:US
Mailing Address - Phone:917-238-7234
Mailing Address - Fax:
Practice Address - Street 1:1844 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2426
Practice Address - Country:US
Practice Address - Phone:917-238-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty