Healthcare Provider Details

I. General information

NPI: 1326719733
Provider Name (Legal Business Name): ILYAGU MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W 9TH ST
BROOKLYN NY
11231-2501
US

IV. Provider business mailing address

221 SEA BREEZE AVE APT PH2B
BROOKLYN NY
11224-3454
US

V. Phone/Fax

Practice location:
  • Phone: 646-687-2838
  • Fax:
Mailing address:
  • Phone: 646-687-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NABEEL BABAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 646-687-2838