Provider Demographics
NPI:1730613712
Name:ILLYAS, WAJIHA (MD)
Entity type:Individual
Prefix:
First Name:WAJIHA
Middle Name:
Last Name:ILLYAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 5TH ST
Mailing Address - Street 2:259 1ST ST, WINTHROP 2, RM 291
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-663-8963
Mailing Address - Fax:516-663-8964
Practice Address - Street 1:2282 5TH ST
Practice Address - Street 2:259 1ST ST, WINTHROP 2, RM 291
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-663-8963
Practice Address - Fax:516-663-8964
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI420866010628207R00000X
NY314406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine