Provider Demographics
NPI:1265428528
Name:SHNEYDERMAN, ILYA
Entity type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:SHNEYDERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 49TH ST
Mailing Address - Street 2:DEPARTMENT OF NEPHROLOGY ROOM #611
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2923
Mailing Address - Country:US
Mailing Address - Phone:718-510-2557
Mailing Address - Fax:718-283-6621
Practice Address - Street 1:953 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2923
Practice Address - Country:US
Practice Address - Phone:718-510-2557
Practice Address - Fax:718-283-6621
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81790207RN0300X
NY214315207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02150714Medicaid
NY02150714Medicaid
NY15S532Medicare ID - Type Unspecified