Healthcare Provider Details

I. General information

NPI: 1013302322
Provider Name (Legal Business Name): DR. SOFYA ILMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE STE M100
NEW HYDE PARK NY
11042-2062
US

IV. Provider business mailing address

1991 MARCUS AVE STE M100
NEW HYDE PARK NY
11042-2062
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-3750
  • Fax:
Mailing address:
  • Phone: 516-472-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number285311
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number285311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: