Provider Demographics
NPI:1164432043
Name:LEFKOWICZ, ILYSE SIMONE (MD)
Entity Type:Individual
Prefix:DR
First Name:ILYSE
Middle Name:SIMONE
Last Name:LEFKOWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 5TH AVE
Mailing Address - Street 2:# 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4952
Mailing Address - Country:US
Mailing Address - Phone:212-288-3200
Mailing Address - Fax:212-288-3226
Practice Address - Street 1:106 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3574
Practice Address - Country:US
Practice Address - Phone:201-567-8884
Practice Address - Fax:201-567-1707
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237074207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3623885OtherOXFORD
NJ2168222OtherCIGNA
NJ223591934OtherHORIZON
NJ2550613OtherUNITED HEALTH CARE
NJI34685Medicare UPIN
NJ223591934OtherHORIZON