Provider Demographics
NPI:1447327952
Name:BABINER, ILYA (DDS)
Entity type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:BABINER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 BRIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-1930
Mailing Address - Country:US
Mailing Address - Phone:215-702-8865
Mailing Address - Fax:
Practice Address - Street 1:10107 VERREE RD # A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3613
Practice Address - Country:US
Practice Address - Phone:215-698-3710
Practice Address - Fax:215-698-2721
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031068L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017885860001Medicaid