Provider Demographics
NPI:1255429981
Name:BRESLAU, ILANA MICHELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ILANA
Middle Name:MICHELLE
Last Name:BRESLAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 COLUMBUS AVE
Mailing Address - Street 2:APT 10J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6464
Mailing Address - Country:US
Mailing Address - Phone:212-749-3061
Mailing Address - Fax:
Practice Address - Street 1:2 W 86TH ST
Practice Address - Street 2:SUITE #503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3666
Practice Address - Country:US
Practice Address - Phone:917-821-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15484-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist