Healthcare Provider Details

I. General information

NPI: 1528066693
Provider Name (Legal Business Name): ILONA SLUSKER SHTERNFELD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ILONA SLUSKER SHTERNFELD M.D.

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 TAMARACK AVE SUITE 102
SOUTH WINDSOR CT
06074-5539
US

IV. Provider business mailing address

2800 TAMARACK AVE SUITE 102
SOUTH WINDSOR CT
06074-5539
US

V. Phone/Fax

Practice location:
  • Phone: 860-648-0638
  • Fax: 860-648-0870
Mailing address:
  • Phone: 860-648-0638
  • Fax: 860-648-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number041170
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: