Provider Demographics
NPI:1558479311
Name:HERTZ, ILONA HONI (MD)
Entity Type:Individual
Prefix:DR
First Name:ILONA
Middle Name:HONI
Last Name:HERTZ
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 1:400 E 66TH ST
Mailing Address - Street 2:MANHATTAN DIAGNOSTIC RADIOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9314
Mailing Address - Country:US
Mailing Address - Phone:212-838-4243
Mailing Address - Fax:
Practice Address - Street 1:400 E 66TH ST
Practice Address - Street 2:MANHATTAN DIAGNOSTIC RADIOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9314
Practice Address - Country:US
Practice Address - Phone:212-838-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1227302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00507337Medicaid
NY1C0527OtherHEALTHNET
NY00507337Medicaid
NYIH017A2510Medicare ID - Type Unspecified