Provider Demographics
NPI:1750529541
Name:PRILIK MEDICAL PC
Entity type:Organization
Organization Name:PRILIK MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SOFIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRILIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-783-9292
Mailing Address - Street 1:926 EILEEN TER
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1519
Mailing Address - Country:US
Mailing Address - Phone:917-783-9292
Mailing Address - Fax:718-228-8414
Practice Address - Street 1:926 EILEEN TER
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1519
Practice Address - Country:US
Practice Address - Phone:917-783-9292
Practice Address - Fax:718-228-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239234208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI63332Medicare UPIN