Provider Demographics
NPI:1447702014
Name:BAJJO, ILONE
Entity type:Individual
Prefix:
First Name:ILONE
Middle Name:
Last Name:BAJJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ILONE
Other - Middle Name:
Other - Last Name:BAJJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:6 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2408
Mailing Address - Country:US
Mailing Address - Phone:646-404-2946
Mailing Address - Fax:
Practice Address - Street 1:6 LENOX AVE
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552
Practice Address - Country:US
Practice Address - Phone:646-404-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY581683OtherRN
NY581683OtherRN