Provider Demographics
NPI:1699094524
Name:ILIEV, BORIANKA
Entity type:Individual
Prefix:
First Name:BORIANKA
Middle Name:
Last Name:ILIEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CRESCENT DR APT 81
Mailing Address - Street 2:
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-1652
Mailing Address - Country:US
Mailing Address - Phone:845-429-0855
Mailing Address - Fax:
Practice Address - Street 1:508 AIRPORT EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5238
Practice Address - Country:US
Practice Address - Phone:845-425-2655
Practice Address - Fax:845-425-2696
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146236-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse