| NPI | 1093045361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IGOR ILYABAYEV Dentist 516-887-0020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 052814) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2026-08-05 |