Healthcare Provider Details

I. General information

NPI: 1730121211
Provider Name (Legal Business Name): ILANA J GILDERMAN-NEIDENBERG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

14050 NW 14TH ST SUITE 190
SUNRISE FL
33323-2865
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-2000
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberOS8304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: