Provider Demographics
NPI:1316372345
Name:HALLER, ILONA ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:ILONA
Middle Name:ANN
Last Name:HALLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LEXINGTON AVE
Mailing Address - Street 2:APT 4F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8193
Mailing Address - Country:US
Mailing Address - Phone:626-757-4805
Mailing Address - Fax:
Practice Address - Street 1:157 LEXINGTON AVE
Practice Address - Street 2:APT 4F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8193
Practice Address - Country:US
Practice Address - Phone:626-757-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1185041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1185041OtherSPECIAL EDUCATION
NY1185041OtherEARLY CHILDHOOD