NPIMap

Organization Active NPI

Mark Ilyagu Medical PC

  • Internal Medicine Physician
  • Valley Stream, NY
National Provider Identifier
1619699915
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARK ILYAGU MEDICAL PC
Practice address
70 E Sunrise Hwy Ste 500
Valley Stream, NY 11581-1233
Phone
(717) 716-7107
NPI assigned
Sep 13, 2022
Last updated
Aug 25, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark IlyaguNPI 1073994711
Title
MD
Phone
(717) 716-7107

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

70 E Sunrise Hwy Ste 500
Valley Stream, NY 11581-1233

Mailing address

221 Sea Breeze Ave Apt PH2B
Brooklyn, NY 11224-3454
Phone (717) 716-7107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221005000992 NY Part B Supplier - Clinic/Group Practice 6800272477 Receives reassigned benefits from 9 practitioners
Practice locations: Staten Island, NY; New York, NY; Flushing, NY; Brooklyn, NY; Bronx, NY
O20260518001048 NJ Part B Supplier - Clinic/Group Practice 6800272477 Receives reassigned benefits from 1 practitioner
Practice locations: Montvale, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787616000000",
    "number": "1619699915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 SEA BREEZE AVE APT PH2B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112243454",
            "telephone_number": "717-716-7107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 E SUNRISE HWY STE 500",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811233",
            "telephone_number": "717-716-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK ILYAGU MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-13",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A",
        "authorized_official_last_name": "ILYAGU",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "717-716-7107"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.