MEDICARE: ILONA SNYDER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	337287	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120919000033	OTHER	NY	FIDELIS CARE NY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205181914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILONA SNYDER NP

Provider Business Mailing Address
First Line	:	2524 ROUTE 9W
Second Line	:
City	:	RAVENA
State	:	NY
Zip	:	12413-2804
Country	:	US
Telephone Number	:	518-756-7390
Fax Number	:	518-756-8030

Provider Business Practice Location Address
First Line	:	2524 ROUTE 9W
Second Line	:
City	:	RAVENA
State	:	NY
Zip	:	12413-2804
Country	:	US
Telephone Number	:	518-756-7390
Fax Number	:	518-756-8030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	03/20/2013

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Directions to “ ILONA SNYDER NP” Practice Location

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