Provider Demographics
NPI:1205181914
Name:SNYDER, ILONA (NP)
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:SNYDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12413-2804
Mailing Address - Country:US
Mailing Address - Phone:518-756-7390
Mailing Address - Fax:518-756-8030
Practice Address - Street 1:2524 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12413-2804
Practice Address - Country:US
Practice Address - Phone:518-756-7390
Practice Address - Fax:518-756-8030
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY120919000033OtherFIDELIS CARE NY
NY03476331Medicaid
NYJ400076716Medicare PIN
NYJ400076715Medicare PIN