Organization
MODERN MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILYA KLEYN (MD)
(212) 571-5000
Entity
Organization
Contact information
Practice address
225 BROADWAY STE 910, NEW YORK, NY 10007-3008
(212) 571-5000
(212) 571-5001
Mailing address
225 BROADWAY STE 910, NEW YORK, NY 10007-3008
(212) 571-5000
(212) 571-5001
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
215006
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02091596
—
NY
Enumeration date
09/24/2006
Last updated
03/07/2025
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