Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 25MA08186100 | NJ |
NPI | 1659416360 |
---|---|
Provider Name | Liesl Pia Iledan |
First Address | Elmhurst, NY 11373-3660 |
Second Address | Toms River, NJ 08755-6423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |