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General NPI Number Information
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NPI Number | 1548700925
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Entity Type | Organization
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Legal Business Name | SPECIAL MEDICAL PC
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Dates
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Enumeration Date | 03/03/2017
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 699 B STANLEY AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11207
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Country | US
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Telephone | 347-689-8880
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Fax | 347-689-8860
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Provider Business Mailing Address
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Address Line | 225 BROADWAY STE 910
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City | NEW YORK
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State | NY
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Zip | 10007-3008
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Country | US
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Telephone | 212-571-5000
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Fax | 347-689-8860
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Authorized Official
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Title or Position | PRESIDENT
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Name | ILYA KLEYN
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Credential | M.D.
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Telephone | 212-571-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 215006
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License Number State | NY
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