Individual provider Active NPI

Gavriil Ilizarov, D.O.

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
National Provider Identifier
1982969788
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
280530 Issued in NY
Practice address
240 E 38TH St FL 15
New York, NY 10016-2708
Phone
(212) 263-6037
NPI assigned
Jul 8, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physical Medicine & Rehabilitation Physician 208100000X 280530 NY Primary

Addresses

Primary practice location

240 E 38TH St FL 15
New York, NY 10016-2708

Mailing address

550 1St Ave
New York, NY 10016-6402

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gilizarov79038@nyumc.direct-ci.com

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
I20160519001431 NY Practitioner - Physical Medicine and Rehabilitation 9234428939 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

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

530 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

550 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

560 1St Ave
New York, NY 10016-6402
Phone (212) 263-7300

Hospital & facility affiliations

  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
280530NYMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University Physical Medicine & Rehabilitation CurrentSince Jun 1, 2016 Accepting new patients
New York University Physical Medicine & Rehabilitation CurrentSince Jun 1, 2016 Accepting new patients
New York City Health and Hospitals Corporation CurrentSince Jan 15, 2020 Accepting new patients
New York City Health and Hospitals Corporation Current Accepting new patients
New York City Health and Hospitals Corporation Physical Medicine & Rehabilitation CurrentSince Jan 15, 2020 Accepting new patients

Locations

40 Heyward St
Brooklyn, NY 11249
Phone (212) 727-9997

227 Madison St
New York, NY 10002
Phone (212) 238-7000

550 1st Ave
New York, NY 10016
Phone (212) 263-3293

120 W 106th St
New York, NY 10025
Phone (212) 870-4715

240 E 38th St
Fl 15
New York, NY 10016
Phone (212) 263-6037

50 Water St
Fl 3
New York, NY 10004

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

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

Interoperability endpoints

  • Direct secure messaging: gilizarov79038@nyumc.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1341705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1982969788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 1ST AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 E 38TH ST FL 15",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100162708",
            "telephone_number": "212-263-6037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILIZAROV",
        "first_name": "GAVRIIL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-08",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "280530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gilizarov79038@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "240 E 38th St Fl 15",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100162708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.