Ivanov, Ilya
Ivanov, Ilya is an individual health care provider with primary practice located at 100 Century Pkwy Ste 350 , Mount Laurel NJ 08054-1149. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Ivanov, Ilya can be contacted via phone (856) 482-9000.Contact Information
Primary practice address
100 Century Pkwy Ste 350
Mount Laurel NJ 08054-1149
Phone: (856) 482-9000
Fax: (856) 482-1159
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 025MB8329500 | New Jersey |
Profile Details
| NPI number | 1487848149 |
|---|---|
| LBN Legal business name | Ivanov, Ilya |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 5th, 2007 |
| Last updated | Mar 14th, 2024 - about 6 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487848149 | NPPES |
| New Jersey | Other | P00772213 | RAILROAD MEDICARE |
| New Jersey | MEDICAID | 0211699 | RAILROAD MEDICARE |
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