Provider Demographics
NPI:1982786877
Name:LEV-EL, ILANA (PSYD)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:LEV-EL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OAK DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4809
Mailing Address - Country:US
Mailing Address - Phone:973-895-3833
Mailing Address - Fax:
Practice Address - Street 1:20 OAK DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4809
Practice Address - Country:US
Practice Address - Phone:973-895-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100196600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ581721Medicare ID - Type Unspecified