Provider Demographics
NPI:1154785350
Name:GARBER, ILYSE (LAC, DIPLAC)
Entity type:Individual
Prefix:MS
First Name:ILYSE
Middle Name:
Last Name:GARBER
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ANDREAS
Mailing Address - State:PA
Mailing Address - Zip Code:18211-3217
Mailing Address - Country:US
Mailing Address - Phone:610-714-2223
Mailing Address - Fax:
Practice Address - Street 1:2047 PA ROUTE 309
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9307
Practice Address - Country:US
Practice Address - Phone:484-619-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2022-11-21
Deactivation Date:2016-09-12
Deactivation Code:
Reactivation Date:2022-11-21
Provider Licenses
StateLicense IDTaxonomies
PAAK001169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist