Provider Demographics
NPI:1639698830
Name:ILENA ROTUNDO
Entity Type:Organization
Organization Name:ILENA ROTUNDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-225-0286
Mailing Address - Street 1:3805 TORRES CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-8119
Mailing Address - Country:US
Mailing Address - Phone:561-225-0286
Mailing Address - Fax:
Practice Address - Street 1:3805 TORRES CIR.
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-225-0286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILENA ROTUNDO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL673916Medicaid