Provider Demographics
NPI:1457557522
Name:SOLOMON, ILENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:
Last Name:SOLOMON
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 1:74 SHRUB HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3110
Mailing Address - Country:US
Mailing Address - Phone:516-747-8583
Mailing Address - Fax:516-747-8583
Practice Address - Street 1:74 SHRUB HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3110
Practice Address - Country:US
Practice Address - Phone:516-747-8583
Practice Address - Fax:516-747-8583
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007857103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV14104Medicare ID - Type Unspecified