Provider Demographics
NPI:1659595221
Name:ILEDAN, CELINE E (RD,CDN)
Entity Type:Individual
Prefix:
First Name:CELINE
Middle Name:E
Last Name:ILEDAN
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 KETCHAM ST
Mailing Address - Street 2:5A
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3660
Mailing Address - Country:US
Mailing Address - Phone:718-429-6234
Mailing Address - Fax:
Practice Address - Street 1:83 MAIDEN LANE 5TH FLOOR
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10038-4812
Practice Address - Country:US
Practice Address - Phone:212-780-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL821891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered