Provider Demographics
NPI:1316914021
Name:PILDYSH, INNA (DO)
Entity type:Individual
Prefix:DR
First Name:INNA
Middle Name:
Last Name:PILDYSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 65TH STREET
Mailing Address - Street 2:COMPASSIONATE MEDICINE P.C.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-645-4800
Mailing Address - Fax:718-645-4949
Practice Address - Street 1:2345 65TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-645-4800
Practice Address - Fax:718-645-4949
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02228013Medicaid
H57668Medicare UPIN
NY02228013Medicaid