LARISA ILYUTOVICH (NPI# 1780033225) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780033225 |
| Entity Type | Individual |
| Full Name | LARISA ILYUTOVICH |
| Practice Address |
301 Bridge Plz N Suite 2 Fort Lee NJ 07024-5059 |
| Practice Telephone | 2013464660 |
| Practice Fax Number | 2013461116 |
| Mailing Telephone | 2013464660 |
| Mailing Fax Number | 2013461116 |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DI020299 | NJ | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 8797404 | 05 |
| Street Address |
301 BRIDGE PLZ N SUITE 2 |
| City | FORT LEE |
| State | NJ |
| Zip Code | 07024-5059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629045539 | Arlene Michele Rosenberg Henick | Ophthalmology | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2006-03-01 |
| 1689283228 | Michael John Marcano | Physical Therapist | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2020-07-29 |
| 1417328964 | Michael Dwyer | Physical Therapist | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2015-10-09 |
| 1154707941 | James Kim | Physical Therapist | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2015-08-04 |
| 1114279270 | Mihee Suh | Physical Therapist | 301 Bridge Plz N, Fort Lee Physical Therapy, Fort Lee, NJ 07024-5059 | 2012-10-12 |
| 1093093734 | Harrison Leigh Rosenberg | Optometrist | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2011-07-29 |
| 1568612992 | Hyun Joo Park | Physical Therapist | 301 Bridge Plz N, Fort Lee Physical Therapy, Fort Lee, NJ 07024-5059 | 2008-09-22 |
| 1700062502 | Seligman Rosenbergm.d. | Eyewear Supplier (Equipment, not the service) | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2008-01-11 |
| 1003098724 | Olga Michaud | Dentist | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2007-12-05 |
| 1841490570 | Bridge Opticians, LLC | Optometrist | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2007-07-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043828726 | You S Jung | Pharmacist | 1275 15th Street Apt 2e, Fort Lee, NJ 07024 | 2020-07-17 |
| 1205316528 | Professional Orthopedic and Sports Therapy of Nj, LLC | Physical Therapist | 2200 Fletcher Ave Ste 505, Fort Lee, NJ 07024 | 2018-08-16 |
| 1194210138 | Hyunjoo Lee | Pharmacy | 168 Fletcher Ave, Fort Lee, NJ 07024 | 2018-06-22 |
| 1912423724 | Fort Lee Health Supplies | Durable Medical Equipment & Medical Supplies | 96 Linwood Plaza Rte 9 W, Fort Lee, NJ 07024 | 2017-08-15 |
| 1669997482 | Jinseok Woo | Acupuncturist | 6 Horizon Rd., Apt 2504, Fort Lee, NJ 07024 | 2017-08-14 |
| 1578083705 | Sheran Rey | Licensed Vocational Nurse | 6308 Hilltop Ct, Fort Lee, NJ 07024 | 2017-06-20 |
| 1558812909 | Jian Cui | Acupuncturist | 500 Linwood Drive Apt3c, Fort Lee, NJ 07024 | 2016-10-20 |
| 1013392919 | Yulong Yang | Internal Medicine | 2083 Center Ave Ste 2a, Fort Lee, NJ 07024 | 2015-07-22 |
| 1235561796 | Anthony Lucev | Student in an Organized Health Care Education/Training Program | 233 Harmon Ave, Fort Lee, NJ 07024 | 2013-08-06 |
| 1811331598 | Bridgeview Rehabilitation and Medical Arts Center | Physical Medicine & Rehabilitation | 454 Main Street 3rd Floor, Fort Lee, NJ 07024 | 2013-04-24 |
| Find all providers in zip 07024 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194214072 | Ji Yen Suh | Dentist | 1600 Parker Ave Apt 16f, Fort Lee, NJ 07024-7006 | 2018-05-06 |
| 1538697081 | Christine Chun | Dentist | 1636 Parker Ave Fl 2, Fort Lee, NJ 07024-6926 | 2017-05-29 |
| 1366890642 | Fort Lee Smiles | Dentist | 1530 Palisade Ave Ste 101, Fort Lee, NJ 07024-5470 | 2016-05-27 |
| 1720440415 | Maria Apergis | Dentist | 1515 Palisade Ave, Fort Lee, NJ 07024-5345 | 2016-03-22 |
| 1821471897 | Igor Igdalev | Dentist | 1625 Anderson Ave Ste 202, Fort Lee, NJ 07024-2748 | 2015-07-08 |
| 1316351364 | Ana Kim | Dentist | 2077 Center Ave Apt 9f, Fort Lee, NJ 07024-4903 | 2014-06-18 |
| 1942579768 | Francis Sangik Han | Dentist | 158 English St Unit A, Fort Lee, NJ 07024-6904 | 2011-12-22 |
| 1538334867 | Byongyool Alan Kim | Dentist | 891 Palisade Ave, Fort Lee, NJ 07024-4122 | 2008-04-28 |
| 1598937609 | Sherif S Radwan | Dentist | 1585 Palisade Ave, Fort Lee, NJ 07024-6931 | 2008-03-28 |
| 1578754008 | Mina Kim | Dentist | 328 Bridge Plz N Apt 1h, Fort Lee, NJ 07024-5013 | 2007-08-08 |
| Find all providers in FORT LEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.