Provider Demographics
NPI:1689839417
Name:KANOVSKY, ILANA (OT)
Entity type:Individual
Prefix:MRS
First Name:ILANA
Middle Name:
Last Name:KANOVSKY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 BROAD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1637
Mailing Address - Country:US
Mailing Address - Phone:646-302-9624
Mailing Address - Fax:
Practice Address - Street 1:481 BROAD AVE FL 1
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1637
Practice Address - Country:US
Practice Address - Phone:646-302-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00378700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist