Provider Demographics
NPI:1477130961
Name:GERSOWSKY, ILANA RACHEL (DO)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:RACHEL
Last Name:GERSOWSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 BUENA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8202
Mailing Address - Country:US
Mailing Address - Phone:609-214-2203
Mailing Address - Fax:
Practice Address - Street 1:7895 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2600
Practice Address - Country:US
Practice Address - Phone:954-752-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics