Provider Demographics
NPI:1356134241
Name:KAMILLA ISMAILOFF, MD, PC
Entity type:Organization
Organization Name:KAMILLA ISMAILOFF, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAILOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-414-2345
Mailing Address - Street 1:6910 108TH ST APT 9E
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3814
Mailing Address - Country:US
Mailing Address - Phone:347-414-2345
Mailing Address - Fax:631-938-0648
Practice Address - Street 1:11014 LIBERTY AVE FL 1
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1706
Practice Address - Country:US
Practice Address - Phone:347-414-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty