Healthcare Provider Details

I. General information

NPI: 1336502954
Provider Name (Legal Business Name): ILAN KENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST # 1259
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

8 LEVITAN ST. APT. #28
TEL AVIV ISRAEL
6920410
IL

V. Phone/Fax

Practice location:
  • Phone: 212-241-5972
  • Fax:
Mailing address:
  • Phone: 972507987000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: