| Ilyagu Medical Pc | |
|
811 Southern Blvd Bronx NY 10459-5202 | |
| (717) 716-7107 | |
| Not Available |
| Full Name | Ilyagu Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 811 Southern Blvd, Bronx, New York |
| Authorized Official Name and Position | Mark Ilyagu (OWNER) |
| Authorized Official Contact | 7177167107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ilyagu Medical Pc 221 Sea Breeze Ave Apt Ph2b Brooklyn NY 11224-3454 Ph: (717) 716-7107 | Ilyagu Medical Pc 811 Southern Blvd Bronx NY 10459-5202 Ph: (717) 716-7107 |
| NPI Number | 1730859935 |
|---|---|
| Provider Enumeration Date | 09/18/2021 |
| Last Update Date | 06/10/2024 |
| Medicare PECOS PAC ID | 1658751417 |
|---|---|
| Medicare Enrollment ID | O20220711001740 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730859935 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Allette Mcpherson-cunningham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386952323 PECOS PAC ID: 4587979794 Enrollment ID: I20150818003794 |
| Provider Name | Bhupinderjit Singh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225490956 PECOS PAC ID: 5092003665 Enrollment ID: I20161013002379 |
| Provider Name | Mark Ilyagu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073994711 PECOS PAC ID: 8820340151 Enrollment ID: I20181015000980 |
| Provider Name | Pamela A Rizkalla |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1891131124 PECOS PAC ID: 9931495223 Enrollment ID: I20200422000996 |
| Provider Name | Tremaine Wright |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093247926 PECOS PAC ID: 2961897798 Enrollment ID: I20220315000568 |
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