Provider Demographics
NPI:1720024995
Name:ILARIO, MARIUS J-M (MD)
Entity Type:Individual
Prefix:
First Name:MARIUS
Middle Name:J-M
Last Name:ILARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:535 E CRESCENT AVE
Mailing Address - Street 2:C/O HISTOPATHOLOGY SERVICES, LLC
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2922
Mailing Address - Country:US
Mailing Address - Phone:201-661-7280
Mailing Address - Fax:201-661-7297
Practice Address - Street 1:535 E CRESCENT AVE
Practice Address - Street 2:C/O HISTOPATHOLOGY SERVICES, LLC
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2922
Practice Address - Country:US
Practice Address - Phone:201-661-7280
Practice Address - Fax:201-661-7297
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222763207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03039916Medicaid
NYA400062578Medicare PIN
NYI24241Medicare UPIN
NY57R261Medicare ID - Type Unspecified