Active NPI
Valentin Ilivitsky, MD
- Anesthesiology Physician
- Philadelphia, PA
National Provider Identifier
1649211400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD425312
- Practice address
- 51 N 39TH St
Philadelphia, PA 19104-2640 - Phone
- (215) 662-8000
- NPI assigned
- Jun 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD425312 | PA | Primary |
Addresses
Primary practice location
51 N 39TH St
Philadelphia, PA 19104-2640
Mailing address
51 N 39TH St
Philadelphia, PA 19104-2640
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1011798090001 | Medicaid | MD |
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298332800000",
"number": "1649211400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 N 39TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 N 39TH ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191042640",
"telephone_number": "215-662-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILIVITSKY",
"first_name": "VALENTIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-10",
"last_updated": "2011-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "PA",
"license": "MD425312",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1011798090001",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.