Individual provider Active NPI

Wajiha Illyas, MD

  • Internal Medicine Physician
  • Mineola, NY
National Provider Identifier
1730613712
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
314406 Issued in NY
Practice address
2282 5TH St
259 1St St, Winthrop 2, RM 291
Mineola, NY 11501
Phone
(516) 663-8963
Fax
(516) 663-8964
NPI assigned
Apr 17, 2017
Last updated
Apr 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 420866010628 MI
Internal Medicine Physician 207R00000X 314406 NY Primary

Addresses

Primary practice location

2282 5TH St
259 1St St, Winthrop 2, RM 291
Mineola, NY 11501

Mailing address

2282 5TH St
259 1St St, Winthrop 2, RM 291
Mineola, NY 11501
Phone (516) 663-8963

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220803001582 NY Practitioner - Internal Medicine 0749524031 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians
Southwest Suffolk Medical PCGroup PAC ID 0244396349, 204 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

50 Route 25a
Smithtown, NY 11787-1348
Phone (631) 862-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
420866010628MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Internal Medicine CurrentSince Mar 31, 2024 Accepting new patients
Southwest Suffolk Medical, P.C. CurrentSince Nov 1, 2022 Accepting new patients
New York University Internal Medicine CurrentSince May 1, 2025 Accepting new patients
New York University Internal Medicine CurrentSince May 1, 2025 Accepting new patients
Southwest Suffolk Medical PC CurrentSince Nov 1, 2022 Accepting new patients
Cogent Medical Care PC Internal Medicine CurrentSince Jan 1, 2022 Accepting new patients
St Charles Hospital Corp Past Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

565 Abbott Rd
Rm 8632
Buffalo, NY 14220
Phone (607) 798-5671

2201 Hempstead Tpke
East Meadow, NY 11554
Phone (516) 486-6862

300 Community Dr
Manhasset, NY 11030

259 1st St
Rm 291
Mineola, NY 11501
Phone (516) 663-8693

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

101 Hospital Rd
Patchogue, NY 11772
Phone (631) 654-7100

160 E Main St
Port Jervis, NY 12771
Phone (845) 856-7000

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

48 Route 25A
Smithtown, NY 11787
Phone (631) 862-3540

50 Route 25A
Smithtown, NY 11787
Phone (631) 465-6225

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: willyas504422@nyumc.direct-ci.com

Organizations & group practices 7

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1730613712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2282 5TH ST",
            "address_2": "259 1ST ST, WINTHROP 2, RM 291",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "11501",
            "telephone_number": "516-663-8963",
            "fax_number": "516-663-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2282 5TH ST",
            "address_2": "259 1ST ST, WINTHROP 2, RM 291",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "11501",
            "telephone_number": "516-663-8963",
            "fax_number": "516-663-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLYAS",
        "first_name": "WAJIHA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-17",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "420866010628",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "314406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.