Ilyutovich, Larisa
Ilyutovich, Larisa is an sole proprietor health care provider with primary practice located at 301 Bridge Plz N Suite 2, Fort Lee NJ 07024-5059. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Ilyutovich, Larisa can be contacted via phone (201) 346-4660.Contact Information
Primary practice address
301 Bridge Plz N Suite 2
Fort Lee NJ 07024-5059
Phone: (201) 346-4660
Fax: (201) 346-1116
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | DI020299 | New Jersey |
Profile Details
| NPI number | 1780033225 |
|---|---|
| LBN Legal business name | Ilyutovich, Larisa |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 6th, 2016 |
| Last updated | Jun 6th, 2016 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780033225 | NPPES |
| New Jersey | MEDICAID | 8797404 |
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