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Organization
IYAR MEDICAL PC
Active
Organization
IYAR MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIKOLAI LAGODUKE MD (OWNER)
(877) 849-4917
Entity
Organization
Contact information
Practice address
7235 112TH ST, SUITE # PR9,, FOREST HILLS, NY 11375-5469
(877) 849-4917
(877) 949-4917
Mailing address
7235 112TH ST, SUITE # PR9,, FOREST HILLS, NY 11375-5469
(877) 849-4917
(877) 949-4917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
233906
NY
225100000X
Physical Therapist
030904
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000119919
GHI HMO
NY
01
—
00002513975 09
UNITED HEALTHCARE
NY
01
—
000399390201
HEALTHPLUS
NY
05
—
02619565
—
NY
01
—
11P12182
NY PRESBYTERIAN
NY
01
—
179953
ELDERPLAN
NY
01
—
233906
HIP
NY
01
—
268SV1
EMPIRE BLUE CROSS AND BLU
NY
01
—
6C5025
HEALTHNET
NY
01
—
P3725574
OXFORD
NY
01
—
PCP ID# 5416260001
CIGNA
NY
Enumeration date
02/07/2007
Last updated
07/14/2009
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