Provider Demographics
NPI:1205151230
Name:PRISCILLA G. ILEM, MD, MPH, LLC
Entity type:Organization
Organization Name:PRISCILLA G. ILEM, MD, MPH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ILEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-628-1017
Mailing Address - Street 1:782 ALPS ROAD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3920
Mailing Address - Country:US
Mailing Address - Phone:973-628-1017
Mailing Address - Fax:973-694-1362
Practice Address - Street 1:782 ALPS ROAD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3920
Practice Address - Country:US
Practice Address - Phone:973-628-1017
Practice Address - Fax:973-694-1362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRISCILLA G. ILEM, MD, MPH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02352502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64547Medicare UPIN