Active NPI
Iliya Nisen, PHARM D
- Pharmacist
- Brooklyn, NY
National Provider Identifier
1457768012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 059347
- Practice address
- 1598 Flatbush Ave
Brooklyn, NY 11210-3251 - Phone
- (718) 637-5006
- NPI assigned
- Jul 16, 2014
- Last updated
- Oct 2, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 059347 | NY | Primary |
Addresses
Primary practice location
1598 Flatbush Ave
Brooklyn, NY 11210-3251
Mailing address
1753 E 12TH St Apt 2B
Brooklyn, NY 11229-1096
Phone (646) 797-1514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059347 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Past | Accepting new patients | |
| CVS Albany LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538438400000",
"number": "1457768012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1753 E 12TH ST APT 2B",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112291096",
"telephone_number": "646-797-1514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1598 FLATBUSH AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112103251",
"telephone_number": "718-637-5006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISEN",
"first_name": "ILIYA",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-16",
"last_updated": "2018-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "059347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.