Individual
IRINA ILYASOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
8686 BAY PKWY, STE M4, BROOKLYN, NY 11214-5103
(718) 265-7700
(718) 265-7701
Mailing address
62 KEUNE CT, STATEN ISLAND, NY 10304-1431
(718) 265-7700
(718) 265-7701
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
013442
NY
Other
Enumeration date
10/30/2009
Last updated
10/30/2009
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