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

Nikol Ilyasov, PA-C

Individual provider Physician Assistant · NPI 1386367142

Nikol Ilyasov, PA-C is a Physician Assistant in Greenvale, New York. Qualified in 2021, 5 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group.

Years since qualifying
5
In the registry since
2022
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2200 Northern Blvd
Greenvale, NY 11548-1219
Phone: (877) 896-9301
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1386367142
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 26, 2022
Last updated in NPPESJune 12, 2023
Certification dateJune 1, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Not indicated
Practice locations6 on file with Medicare

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