Healthcare Provider Details

I. General information

NPI: 1720436322
Provider Name (Legal Business Name): ILIRJANA DUKA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

355 BARD AVE DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
STATEN ISLAND NY
10310-1664
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-2419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number316544
License Number StateNY
# 2
Primary TaxonomyN
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: