Provider Demographics
NPI:1336257468
Name:MIRECKI, ILONA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILONA
Middle Name:
Last Name:MIRECKI
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 1:12 E 86TH ST
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0506
Mailing Address - Country:US
Mailing Address - Phone:917-273-4411
Mailing Address - Fax:
Practice Address - Street 1:12 E 86TH ST
Practice Address - Street 2:SUITE1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0506
Practice Address - Country:US
Practice Address - Phone:917-273-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1523302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry