Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 037930 | NY |
NPI | 1003274143 |
---|---|
Provider Name | Ana Ilijeska |
First Address | New York, NY 10010-3134 |
Second Address | New York, NY 10010-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 03/02/2016 |