Provider Demographics
NPI:1982994141
Name:KUSTANOWITZ, ILANA (PHD)
Entity type:Individual
Prefix:DR
First Name:ILANA
Middle Name:
Last Name:KUSTANOWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1535
Mailing Address - Country:US
Mailing Address - Phone:347-920-3036
Mailing Address - Fax:
Practice Address - Street 1:3755 HENRY HUDSON PKWY
Practice Address - Street 2:APT 6A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1535
Practice Address - Country:US
Practice Address - Phone:347-920-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018417103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool