Individual
ILYAS LIVENTSOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNPC-AG
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-5540
Mailing address
750 E ADAMS ST FL 8, SYRACUSE, NY 13210-2306
(315) 464-1800
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
432158
NY
363LA2100X
Acute Care Nurse Practitioner
Primary
F432158
NY
Other
Enumeration date
09/27/2021
Last updated
09/27/2021
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