Basic Information
| Provider Information | |||||||||
| NPI: | 1497789218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSTEL | ||||||||
| FirstName: | ILONA | ||||||||
| MiddleName: | KERTESZ | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270-05 76TH AVENUE, | ||||||||
| Address2: | LONG ISLAND JEWISH MEDICAL CENTER, DEPT OF OB/GYN | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 COLLINS LN | ||||||||
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| City: | WEST HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115522922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163959340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 360434 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 290F000495 | 05 | NY | MEDICAID |