Provider Demographics
NPI:1093078545
Name:IFILL, ARLENE N (MSED)
Entity Type:Individual
Prefix:MISS
First Name:ARLENE
Middle Name:N
Last Name:IFILL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 RESERVOIR OVAL E
Mailing Address - Street 2:608
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-3118
Mailing Address - Country:US
Mailing Address - Phone:718-696-9794
Mailing Address - Fax:
Practice Address - Street 1:3288 RESERVOIR OVAL E
Practice Address - Street 2:608
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3118
Practice Address - Country:US
Practice Address - Phone:718-696-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist