Provider Demographics
NPI:1558394312
Name:ILYAYEVA, IRINA (MD)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:ILYAYEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 92ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7929
Mailing Address - Country:US
Mailing Address - Phone:917-832-6562
Mailing Address - Fax:646-930-5556
Practice Address - Street 1:3703 92ND ST FL 1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7929
Practice Address - Country:US
Practice Address - Phone:917-832-6562
Practice Address - Fax:646-930-5556
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY237803208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02710218Medicaid
NY02710218Medicaid
NY5330QFMedicare PIN
NYI47858Medicare UPIN