Provider Demographics
NPI:1306941711
Name:LANTSBERG, ILYA Y (MD)
Entity type:Individual
Prefix:DR
First Name:ILYA
Middle Name:Y
Last Name:LANTSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ILYA
Other - Middle Name:Y
Other - Last Name:SELEZNEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:221 MIDDLE NECK RD APT 6K
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1129
Mailing Address - Country:US
Mailing Address - Phone:718-809-1630
Mailing Address - Fax:
Practice Address - Street 1:221 MIDDLE NECK RD APT 6K
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1129
Practice Address - Country:US
Practice Address - Phone:718-809-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240171207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine