Provider Demographics
NPI:1134647340
Name:GENIN, ILANA (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:GENIN
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:
Other - Last Name:KATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, FNP-BC
Mailing Address - Street 1:3 NIAGARA WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1328
Mailing Address - Country:US
Mailing Address - Phone:917-715-9012
Mailing Address - Fax:
Practice Address - Street 1:3 NIAGARA WAY
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1328
Practice Address - Country:US
Practice Address - Phone:917-715-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00743400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty