MEDICARE: ILYAS ARANBAYEV FNP

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	363LF0000X	Family Nurse Practitioner	345438	NY

General Provider Information

NPI Number	:	1528653631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYAS ARANBAYEV FNP

Provider Business Mailing Address
First Line	:	8538 123RD ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3317
Country	:	US
Telephone Number	:	917-828-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	8538 123RD ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3317
Country	:	US
Telephone Number	:	917-828-3474
Fax Number	:

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

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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