Provider Demographics
NPI:1699376251
Name:GAMER, ILONA
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:GAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2505
Mailing Address - Country:US
Mailing Address - Phone:917-439-0931
Mailing Address - Fax:800-888-2705
Practice Address - Street 1:2525 E 23RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2505
Practice Address - Country:US
Practice Address - Phone:917-439-0931
Practice Address - Fax:800-888-2705
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist