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General NPI Number Information
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NPI Number | 1518987510
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Entity Type | Individual
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Provider Name | ILIYAN STOYANOV IVANOV M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L LEVY PL # 1228
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City | NEW YORK
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State | NY
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Zip | 10029-6500
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Country | US
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Telephone | 212-659-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 235 E 95TH ST APT 26C
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City | NEW YORK
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State | NY
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Zip | 10128-0229
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Country | US
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Telephone | 646-387-6080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 60-220252
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License Number State | NY
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