Individual
ILENE FENNOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3959 BROADWAY, CHN 106, NEW YORK, NY 10032
(212) 305-6559
(212) 305-4778
Mailing address
630 W 168TH ST, PH5E 522, NEW YORK, NY 10032
(212) 305-6559
(212) 305-4778
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
122361
NY
2080P0205X
Pediatric Endocrinology Physician
Primary
122361
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01126769
—
NY
Enumeration date
08/16/2005
Last updated
09/11/2025
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