Provider Demographics
NPI:1588117261
Name:TOLEDO, ILEANA (PT)
Entity type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:TOLEDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1719
Mailing Address - Country:US
Mailing Address - Phone:201-410-7181
Mailing Address - Fax:
Practice Address - Street 1:1060 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2591
Practice Address - Country:US
Practice Address - Phone:201-833-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00438100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist