MEDICARE: ILYA KRAYEVSKY MD

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	207L00000X	Anesthesiology Physician	264881	NY

General Provider Information

NPI Number	:	1407021231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYA KRAYEVSKY MD

Provider Business Mailing Address
First Line	:	3 BOYLE RD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-4000
Country	:	US
Telephone Number	:	631-736-4064
Fax Number	:	631-736-1332

Provider Business Practice Location Address
First Line	:	710 E WALNUT ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3834
Country	:	US
Telephone Number	:	516-521-8003
Fax Number	:

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	07/11/2014

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