Provider Demographics
NPI:1770970170
Name:PRENOVITZ, ILANA RUTH KLEIN (DO)
Entity type:Individual
Prefix:DR
First Name:ILANA
Middle Name:RUTH KLEIN
Last Name:PRENOVITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ILANA
Other - Middle Name:RUTH
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:80 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06102-5037
Mailing Address - Country:US
Mailing Address - Phone:860-679-4988
Mailing Address - Fax:
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052
Practice Address - Country:US
Practice Address - Phone:860-224-5675
Practice Address - Fax:860-224-5774
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61771207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine