MEDICARE: DANIEL ILYABAYEV

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	174400000X	Specialist	2015511261	NY

General Provider Information

NPI Number	:	1902753379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ILYABAYEV

Provider Business Mailing Address
First Line	:	6433 99TH ST APT 3N
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-3542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6433 99TH ST APT 3N
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-3542
Country	:	US
Telephone Number	:	516-652-3287
Fax Number	:

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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