Healthcare Provider Details

I. General information

NPI: 1003763129
Provider Name (Legal Business Name): ILONA WIENER SURICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 ACORN DR
PARAMUS NJ
07652-4144
US

IV. Provider business mailing address

420 ACORN DR
PARAMUS NJ
07652-4144
US

V. Phone/Fax

Practice location:
  • Phone: 201-406-9140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number25MA06074500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: