Provider Demographics
NPI:1982844411
Name:ISABELLA ILARDA M.D., P.C.
Entity Type:Organization
Organization Name:ISABELLA ILARDA M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONTERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-576-5700
Mailing Address - Street 1:6112 69TH ST
Mailing Address - Street 2:P2
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1142
Mailing Address - Country:US
Mailing Address - Phone:718-416-4600
Mailing Address - Fax:718-416-4603
Practice Address - Street 1:6112 69TH ST
Practice Address - Street 2:P2
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1142
Practice Address - Country:US
Practice Address - Phone:718-416-4600
Practice Address - Fax:718-416-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2064011207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty