Basic Information
| Provider Information | |||||||||
| NPI: | 1508938853 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ISLA MEDICAL P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2269 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112293103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183398200 | ||||||||
| FaxNumber: | 7183360069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2269 OCEAN AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112293103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183398200 | ||||||||
| FaxNumber: | 7183360069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | INOYATOVA | ||||||||
| AuthorizedOfficialFirstName: | INNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7183398200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 216437 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02023265 | 05 | NY | MEDICAID |