Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ilyas Liventsov, ACNPC-AG

Individual provider Acute Care Nurse Practitioner · NPI 1760153985

Ilyas Liventsov, ACNPC-AG is a Nurse Practitioner in Syracuse, New York. Qualified in 2021, 5 years ago. Practices with St Josephs Medical PC, a 385-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
5
Licensed in
NY
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

750 E Adams St
Syracuse, NY 13210-2306
Phone: (315) 464-5540
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence F432158 (NY)
Acute Care Nurse Practitioner Taxonomy 363LA2100X · Licence 432158 (NY)

Record details

NPI number1760153985
Entity typeIndividual (Type 1)
GenderMale
Credentials ACNPC-AG
Sole proprietorNo
NPI enumeratedSeptember 27, 2021
Last updated in NPPESSeptember 27, 2021
Certification dateSeptember 27, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice St Josephs Medical Pc — 385 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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