Irina Ilyasov RPA-C

Overview of Irina Ilyasov RPA-C

• NPI number: 1063059160
• Provider type: Individual
• Specialty: Medical
• Gender: Female
• Active since: 10/30/2009
• Last updated: 10/30/2009

Primary Scrop of Practice

• Taxonomy Code: 363AM0700X
• Specialty: Medical
• License Number: 013442
• License State: NY

Provider Mailing Address

• Address: 62 Keune Ct
  Staten Island, NY 10304
• Phone: 718-265-7700
• Fax: 718-265-7701

Provider Practice Location

• Address: 8686 Bay Pkwy
  Ste M4
  Brooklyn, NY 11214
• Phone: 718-265-7700
• Fax: 718-265-7701

Scope of Practice

• Taxonomy Code: 363AM0700X
• Specialty: Medical
• License Number: 013442
• License State: NY
• Switch: Yes