Basic Information
| Provider Information | |||||||||
| NPI: | 1871545400 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BILYK | ||||||||
| FirstName: | IHOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 HIGHVIEW RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | ROCKPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019662209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603486235 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 FRUIT ST | ||||||||
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| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177262000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 54780 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 2080N0001X | 01042406A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 2080N0001X | 64570-20 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 2080N0001X | 234346 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 979197 | 05 | OH | MEDICAID | 110077701A | 05 | MA | MEDICAID | 000000111852 | 01 | BC BS PIN | OTHER | 4229859 | 05 | MI | MEDICAID | 100368270A | 05 | IN | MEDICAID | C6628001 | 01 | CSHCS | OTHER |