Provider Demographics
NPI:1871153338
Name:ILASHUK, OLESYA
Entity type:Individual
Prefix:MISS
First Name:OLESYA
Middle Name:
Last Name:ILASHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1602
Mailing Address - Country:US
Mailing Address - Phone:973-855-7040
Mailing Address - Fax:
Practice Address - Street 1:870 PALISADE AVE STE 302
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3446
Practice Address - Country:US
Practice Address - Phone:201-836-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00924400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health