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General NPI Number Information
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NPI Number | 1134356736
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Entity Type | Organization
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Legal Business Name | ILYA BLOKH MD PC
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 3319 KINGS HWY SUITE 1J
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City | BROOKLYN
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State | NY
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Zip | 11234-2638
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Country | US
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Telephone | 718-676-4067
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Fax | 718-676-4068
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Provider Business Mailing Address
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Address Line | 3319 KINGS HWY SUITE 1J
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City | BROOKLYN
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State | NY
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Zip | 11234-2638
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Country | US
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Telephone | 718-676-4067
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Fax | 718-676-4068
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Authorized Official
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Title or Position | PRESIDENT
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Name | ILYA BLOKH
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Credential | MD
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Telephone | 718-676-4067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 228150
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License Number State | NY
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