Individual
ILYA ZHAVORONKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1425 PORTLAND AVE, ROCHESTER GENERAL HOSPITAL, ROCHESTER, NY 14621-3001
(585) 922-4159
(585) 922-3731
Mailing address
130 ALLENS CREEK RD, ROCHESTER, NY 14618-3305
(585) 410-6545
(585) 410-6560
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
212591-2
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01982567
—
NY
01
—
103217AF
PREFERRED CARE
NY
01
—
2017
EXCELLUS BC/BS
NY
01
—
CAN212591-2W
WORKERS' COMPENSATION
NY
01
—
P010212591
EXCELLUS BLUE CHOICE
NY
Enumeration date
06/08/2006
Last updated
04/23/2021
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