Provider Demographics
NPI:1023315918
Name:ILKHANI, LADAN (MD)
Entity type:Individual
Prefix:DR
First Name:LADAN
Middle Name:
Last Name:ILKHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LADAN
Other - Middle Name:
Other - Last Name:ILKHANIZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:985 CEDARBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4167
Mailing Address - Country:US
Mailing Address - Phone:732-477-5600
Mailing Address - Fax:732-477-1899
Practice Address - Street 1:985 CEDARBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4167
Practice Address - Country:US
Practice Address - Phone:732-477-5600
Practice Address - Fax:732-477-1899
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine