Individual
MR. ILHOM BAKIYEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2601 OCEAN PKWY, BROOKLYN, NY 11235-7745
(718) 616-4797
Mailing address
410 AVENUE X APT 6A, BROOKLYN, NY 11223-6032
(347) 257-7186
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
030168
NY
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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