Provider Demographics
NPI:1629497532
Name:CELIUS, IRLANDE (MS)
Entity Type:Individual
Prefix:
First Name:IRLANDE
Middle Name:
Last Name:CELIUS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BI COUNTY BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3931
Mailing Address - Country:US
Mailing Address - Phone:718-264-1640
Mailing Address - Fax:718-484-0530
Practice Address - Street 1:500 BI COUNTY BLVD STE 114
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3931
Practice Address - Country:US
Practice Address - Phone:718-264-1640
Practice Address - Fax:718-484-0530
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY843903171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor