Provider Demographics
NPI:1336590173
Name:ILONZO, IFEANYI (MD)
Entity Type:Individual
Prefix:
First Name:IFEANYI
Middle Name:
Last Name:ILONZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 BUSHWICK AVE
Mailing Address - Street 2:APARTMENT 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3701
Mailing Address - Country:US
Mailing Address - Phone:267-566-0854
Mailing Address - Fax:
Practice Address - Street 1:894 BUSHWICK AVE
Practice Address - Street 2:APARTMENT 2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3701
Practice Address - Country:US
Practice Address - Phone:267-566-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program