1356336614 NPI number — ILANA ITENBERG DPM

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356336614 NPI number — ILANA ITENBERG DPM

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ITENBERG

Provider First Name:

ILANA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DPM

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1356336614

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/17/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 3677

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NASHUA

Provider Business Mailing Address State Name:

NH

Provider Business Mailing Address Postal Code:

03061-3677

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

603-577-7900

Provider Business Mailing Address Fax Number:

603-577-7972

Provider First Line Business Practice Location Address:

17 PROSPECT ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

NASHUA

Provider Business Practice Location Address State Name:

NH

Provider Business Practice Location Address Postal Code:

03060-3956

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

603-577-3230

Provider Business Practice Location Address Fax Number:

603-577-3234

Provider Enumeration Date:

09/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213ES0131X , with the licence number:  N005742 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 213ES0131X , with the licence number: 000800 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 213ES0131X , with the licence number: 25MD00283300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 213ES0131X , with the licence number: 0317 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 6298914 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 9533745 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: PJ4082 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2701877 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 02459745 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: P3060948 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 161658P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 06 . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".