Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 215268 | NY |
N | 2081S0010X | Sports Medicine | 215268 | NY |
N | 213ES0000X | Sports Medicine | 215268 | NY |
NPI | 1093722183 |
---|---|
Provider Name | Dr. Svetlana Ilizarov |
First Address | Stony Brook, NY 11794-0001 |
Second Address | East Setauket, NY 11733-3495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 27/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2090022 | (05) | NY |
H23143 | (02) | NY |