Provider Demographics
NPI:1730373192
Name:ILYAYEV, RAFAEL IL'ICH (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:IL'ICH
Last Name:ILYAYEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5126
Mailing Address - Country:US
Mailing Address - Phone:347-614-1717
Mailing Address - Fax:
Practice Address - Street 1:499 CROWN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5126
Practice Address - Country:US
Practice Address - Phone:347-614-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine