Provider Demographics
NPI:1235105081
Name:ILARIA, PHILIP V (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:V
Last Name:ILARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1734
Mailing Address - Country:US
Mailing Address - Phone:732-741-1378
Mailing Address - Fax:732-741-1677
Practice Address - Street 1:130 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1734
Practice Address - Country:US
Practice Address - Phone:732-741-1378
Practice Address - Fax:732-741-1677
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA565122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0005859135OtherAETNA
NJ5633605Medicaid
NJ686642CITMedicare ID - Type UnspecifiedPROVIDER
NJ5633605Medicaid