Provider Demographics
NPI:1972696953
Name:BRANDEIS, ILONA VERA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ILONA
Middle Name:VERA
Last Name:BRANDEIS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4804
Mailing Address - Country:US
Mailing Address - Phone:212-696-5880
Mailing Address - Fax:212-696-1089
Practice Address - Street 1:251 E 33RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4804
Practice Address - Country:US
Practice Address - Phone:212-696-5880
Practice Address - Fax:212-696-1089
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130388207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11A511Medicare ID - Type Unspecified
NYB00112Medicare UPIN