Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009519 | NY |
NPI | 1093207839 |
---|---|
Provider Name | Ilya Ilyayev |
First Address | Yonkers, NY 10701-1125 |
Second Address | Yonkers, NY 10701-1125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2018 |
Last Update Date | 06/06/2018 |