Individual
EITAN ILYAYEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
(PA)
Contact information
Practice address
9819 64TH AVE APT 4G, REGO PARK, NY 11374-2526
(718) 483-2731
Mailing address
9819 64TH AVE APT 4G, REGO PARK, NY 11374-2526
(718) 483-2731
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
017825
NY
Other
Enumeration date
08/06/2014
Last updated
08/11/2014
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