Healthcare Provider Details

I. General information

NPI: 1114554672
Provider Name (Legal Business Name): ILANA LEFKOVITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 800
HACKENSACK NJ
07601-1974
US

IV. Provider business mailing address

20 PROSPECT AVE STE 800
HACKENSACK NJ
07601-1974
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA13229400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: