Healthcare Provider Details

I. General information

NPI: 1467575498
Provider Name (Legal Business Name): ILENE KATZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 W 114TH ST MC 3601
NEW YORK NY
10027-7036
US

IV. Provider business mailing address

519 W 114TH ST MC 3601
NEW YORK NY
10027-7036
US

V. Phone/Fax

Practice location:
  • Phone: 212-854-7426
  • Fax:
Mailing address:
  • Phone: 212-854-7426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number309104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: