Provider Demographics
NPI:1255652863
Name:ILIC, MAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJA
Middle Name:
Last Name:ILIC
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 1:8 MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2804
Mailing Address - Country:US
Mailing Address - Phone:914-358-1162
Mailing Address - Fax:
Practice Address - Street 1:210 N CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1949
Practice Address - Country:US
Practice Address - Phone:914-358-1162
Practice Address - Fax:914-368-8343
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2592492084N0402X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty