Dr. Iryna Ilyasova, M.D
Hospitalist in Port Jefferson, NY. Individual provider (NPI-1).
NPI number1073005484
StatusActive
Last updated in NPPESNov 3, 2025
Details
- NPI
- 1073005484
- Entity type
- Individual (NPI-1)
- Name
- Dr. Iryna Ilyasova
- Credential
- M.D
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 31, 2018
- Certification date
- Nov 3, 2025
- Last updated
- Nov 3, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208M00000X | Hospitalist | 311503 | NY | Yes |
| 207R00000X | Internal Medicine | 311503 | NY |
Practice location
75 N Country RdPort Jefferson, NY 11777-2119
Phone 631-473-1320
Mailing address
75 N Country RdPort Jefferson, NY 11777-2119
Phone 631-473-1320
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