Provider Demographics
NPI:1386142180
Name:REFKIN, ILENE MICHELLE
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:MICHELLE
Last Name:REFKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WESTERVELT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-3201
Mailing Address - Country:US
Mailing Address - Phone:201-816-7333
Mailing Address - Fax:201-816-7324
Practice Address - Street 1:60 WESTERVELT AVE STE 2
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-3201
Practice Address - Country:US
Practice Address - Phone:201-816-7333
Practice Address - Fax:201-816-7324
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist