Provider Demographics
NPI:1841284627
Name:KREYNIN, ILYA Z (MD)
Entity type:Individual
Prefix:
First Name:ILYA
Middle Name:Z
Last Name:KREYNIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 N ASTOR ST
Mailing Address - Street 2:APT 15A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2152
Mailing Address - Country:US
Mailing Address - Phone:212-517-9356
Mailing Address - Fax:
Practice Address - Street 1:1335 N ASTOR ST
Practice Address - Street 2:APT 15A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2152
Practice Address - Country:US
Practice Address - Phone:212-517-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155473207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845698Medicaid
NY26H891Medicare ID - Type Unspecified
NY00845698Medicaid