MEDICARE: ROBERT ILYAYEV D.D.S.

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	1223G0001X	General Practice Dentistry	050069	NY

General Provider Information

NPI Number	:	1518967108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ILYAYEV D.D.S.

Provider Business Mailing Address
First Line	:	6260 99TH ST
Second Line	:	APT 1120
City	:	REGO PARK
State	:	NY
Zip	:	11374-1842
Country	:	US
Telephone Number	:	718-896-4023
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ARVERNE
State	:	NY
Zip	:	11692-1271
Country	:	US
Telephone Number	:	718-723-4141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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