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General NPI Number Information
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NPI Number | 1205151230
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Entity Type | Organization
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Legal Business Name | PRISCILLA G. ILEM, MD, MPH, LLC
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 782 ALPS ROAD
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City | WAYNE
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State | NJ
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Zip | 07470-3920
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Country | US
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Telephone | 973-628-1017
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Fax | 973-694-1362
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Provider Business Mailing Address
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Address Line | 782 ALPS ROAD
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City | WAYNE
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State | NJ
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Zip | 07470-3920
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Country | US
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Telephone | 973-628-1017
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Fax | 973-694-1362
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. PRISCILLA G ILEM
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Credential |
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Telephone | 973-628-1017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MA0235250
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License Number State | NJ
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