Provider Demographics
NPI:1548876642
Name:SHIKH, ILYA (DPT)
Entity type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:SHIKH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 AVENUE Y
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2014
Mailing Address - Country:US
Mailing Address - Phone:718-757-9247
Mailing Address - Fax:
Practice Address - Street 1:2748 OCEAN AVE APT 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4735
Practice Address - Country:US
Practice Address - Phone:718-775-8966
Practice Address - Fax:718-866-1034
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist