MEDICARE: ILYA BLOKH MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	228150	NY

General Provider Information

NPI Number	:	1134356736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILYA BLOKH MD PC

Provider Business Mailing Address
First Line	:	3319 KINGS HWY
Second Line	:	SUITE 1J
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2638
Country	:	US
Telephone Number	:	718-676-4067
Fax Number	:	718-676-4068

Provider Business Practice Location Address
First Line	:	3319 KINGS HWY
Second Line	:	SUITE 1J
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2638
Country	:	US
Telephone Number	:	718-676-4067
Fax Number	:	718-676-4068

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ILYA BLOKH
Credential	:	MD
Telephone Number	:	718-676-4067

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	08/13/2012

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