MEDICARE: ILYA BAYTALSKY R.PH.

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	183500000X	Pharmacist	060838	NY

General Provider Information

NPI Number	:	1699151399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYA BAYTALSKY R.PH.

Provider Business Mailing Address
First Line	:	2265 OCEAN PKWY APT 5L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5113
Country	:	US
Telephone Number	:	917-622-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 101ST AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3404
Country	:	US
Telephone Number	:	718-827-4000
Fax Number	:

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	08/04/2015

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