Provider Demographics
NPI:1255953519
Name:VOSK, ILANA (MS, PA-CR)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:VOSK
Suffix:
Gender:F
Credentials:MS, PA-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5238
Mailing Address - Country:US
Mailing Address - Phone:718-200-7730
Mailing Address - Fax:
Practice Address - Street 1:1 DAKOTA DR STE 320
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1136
Practice Address - Country:US
Practice Address - Phone:355-051-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant