Provider Demographics
NPI:1346515558
Name:HELLER, ILENE MADGE
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:MADGE
Last Name:HELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ILENE
Other - Middle Name:
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:333 W 17TH ST
Mailing Address - Street 2:ROOM 111F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5001
Mailing Address - Country:US
Mailing Address - Phone:212-691-6119
Mailing Address - Fax:212-691-6219
Practice Address - Street 1:333 W 17TH ST
Practice Address - Street 2:ROOM 111F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5001
Practice Address - Country:US
Practice Address - Phone:212-691-6119
Practice Address - Fax:212-691-6219
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264730163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool