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NPI Code Detail

MEDICARE: LILY RYAN DIMARTINO PA-C

MEDICARE: LILY RYAN DIMARTINO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant25MP01010300NJ

General Provider Information

NPI Number : 1366268559
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILY RYAN DIMARTINO PA-C
Provider Business Mailing Address
First Line : 200 S ORANGE AVE STE 228
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-5817
Country : US
Telephone Number : 973-322-0133
Fax Number :
Provider Business Practice Location Address
First Line : 200 S ORANGE AVE STE 228
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-5817
Country : US
Telephone Number : 973-322-0133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2024
Last Update Date : 04/07/2026

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Directions to “ LILY RYAN DIMARTINO PA-C” Practice Location

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