Individual
GAVRIIL ILIZAROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
240 E 38TH ST FL 15, NEW YORK, NY 10016-2708
(212) 263-6037
Mailing address
550 1ST AVE, NEW YORK, NY 10016-6402
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
280530
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/08/2012
Last updated
03/25/2021
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