Individual
JAVIER ILLESCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8 N 10TH AVE, MOUNT VERNON, NY 10550-2516
(914) 294-1951
Mailing address
8 N 10TH AVE, MOUNT VERNON, NY 10550-2516
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/09/2018
Last updated
02/09/2023
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