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General NPI Number Information
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NPI Number | 1427254523
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Entity Type | Individual
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Provider Name | VIRGINIA V ILIE NP
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 12/12/2010
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Provider Practice Location Address
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Address Line | 1819 MENAHAN ST 2 R
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City | RIDGEWOOD
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State | NY
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Zip | 11385-1846
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Country | US
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Telephone | 718-386-0905
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E 17TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-3804
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Country | US
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Telephone | 212-598-2368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 30-304691
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License Number State | NY
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