Provider Demographics
NPI:1992969687
Name:ILA A. KEINER LLC
Entity type:Organization
Organization Name:ILA A. KEINER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ILA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KEINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-748-1820
Mailing Address - Street 1:833 E MOSS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4218
Mailing Address - Country:US
Mailing Address - Phone:609-748-1820
Mailing Address - Fax:609-404-3116
Practice Address - Street 1:ROUTE 9 AND CENTRAL AVE
Practice Address - Street 2:CENTRAL SQUARE UNIT 61A
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-748-1820
Practice Address - Fax:609-404-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC460731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ952145Medicare PIN