Provider Demographics
NPI:1205281326
Name:REDMOND, ILANA PRIOR (MD)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:PRIOR
Last Name:REDMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GREENVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2532
Mailing Address - Country:US
Mailing Address - Phone:203-610-4840
Mailing Address - Fax:
Practice Address - Street 1:148 E 38TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2607
Practice Address - Country:US
Practice Address - Phone:844-359-8363
Practice Address - Fax:833-955-3592
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11341000207R00000X
VA0101277557207R00000X
CT70153207R00000X
NJ1992372403261QM2500X
NY1043889967261QM2500X
CT1992372403261QM2500X
NY299440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty