Provider Demographics
NPI:1669602520
Name:SEMANDOV, ILAN (DO)
Entity type:Individual
Prefix:
First Name:ILAN
Middle Name:
Last Name:SEMANDOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:718-237-9305
Practice Address - Street 1:81 SKILLMAN ST
Practice Address - Street 2:ST
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2803
Practice Address - Country:US
Practice Address - Phone:718-694-9000
Practice Address - Fax:718-237-9305
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine