Healthcare Provider Details

I. General information

NPI: 1730098864
Provider Name (Legal Business Name): ILYA ELY SACHAKOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 HEMPSTEAD TPKE
EAST MEADOW NY
11554-2038
US

IV. Provider business mailing address

14905 79TH AVE APT 626
FLUSHING NY
11367-3869
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-9797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056280
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: