MEDICARE: ILYA KRICHAVETS

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	1835I0206X	Infectious Diseases Pharmacist	060476	NY

General Provider Information

NPI Number	:	1962368357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILYA KRICHAVETS

Provider Business Mailing Address
First Line	:	111 E 210TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2401
Country	:	US
Telephone Number	:	718-920-2566
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E 210TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2401
Country	:	US
Telephone Number	:	718-920-2566
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	02/04/2026

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Directions to “ ILYA KRICHAVETS ” Practice Location

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