Provider Demographics
NPI:1952663494
Name:PIERZ, ILENE
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:
Last Name:PIERZ
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 1:35 MAHOPAC AVE
Mailing Address - Street 2:
Mailing Address - City:AMAWALK
Mailing Address - State:NY
Mailing Address - Zip Code:10501-1004
Mailing Address - Country:US
Mailing Address - Phone:914-302-6681
Mailing Address - Fax:
Practice Address - Street 1:20 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5247
Practice Address - Country:US
Practice Address - Phone:914-576-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist