Provider Demographics
NPI:1104615731
Name:ROY, ILONA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:ROY
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8120
Mailing Address - Country:US
Mailing Address - Phone:917-678-5997
Mailing Address - Fax:917-678-5997
Practice Address - Street 1:1 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-8120
Practice Address - Country:US
Practice Address - Phone:917-678-5997
Practice Address - Fax:917-678-5997
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406833363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health