MEDICARE: ILYA SHNEYDERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	ME81790	FL
2	207RN0300X	Nephrology Physician	214315	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265428528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYA SHNEYDERMAN

Provider Business Mailing Address
First Line	:	953 49TH ST
Second Line	:	DEPARTMENT OF NEPHROLOGY ROOM #611
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2923
Country	:	US
Telephone Number	:	718-510-2557
Fax Number	:	718-283-6621

Provider Business Practice Location Address
First Line	:	953 49TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2923
Country	:	US
Telephone Number	:	718-510-2557
Fax Number	:	718-283-6621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	02/12/2014

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Directions to “ ILYA SHNEYDERMAN ” Practice Location

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