Provider Demographics
NPI:1093207839
Name:ILYAYEV, ILYA
Entity type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:ILYAYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 N BROADWAY STE 145
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1125
Mailing Address - Country:US
Mailing Address - Phone:914-376-4000
Mailing Address - Fax:
Practice Address - Street 1:1086 N BROADWAY STE 145
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1125
Practice Address - Country:US
Practice Address - Phone:914-376-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009519156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician