Provider Demographics
NPI:1932475738
Name:DUBIN, ILANA BETH (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:BETH
Last Name:DUBIN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:1 CLUB DR APT 3AR
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2011
Mailing Address - Country:US
Mailing Address - Phone:516-698-9855
Mailing Address - Fax:
Practice Address - Street 1:12915 150TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-4211
Practice Address - Country:US
Practice Address - Phone:718-529-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015873225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist