Provider Demographics
NPI:1821196767
Name:ILANJIAN, GRACE ZENAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ZENAS
Last Name:ILANJIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JOHN R ALBANESE PL
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-4402
Mailing Address - Country:US
Mailing Address - Phone:914-337-3788
Mailing Address - Fax:914-337-3787
Practice Address - Street 1:22 JOHN R ALBANESE PL
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-4402
Practice Address - Country:US
Practice Address - Phone:914-337-3788
Practice Address - Fax:914-337-3787
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE71517Medicare UPIN