Provider Demographics
NPI:1770939662
Name:STOCK, ILANA ROSE (MD)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:ROSE
Last Name:STOCK
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 1:32 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2005
Mailing Address - Country:US
Mailing Address - Phone:201-569-2400
Mailing Address - Fax:201-569-6081
Practice Address - Street 1:350 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2702
Practice Address - Country:US
Practice Address - Phone:201-651-0404
Practice Address - Fax:201-651-0909
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10579000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program