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NPI Code Detail

MEDICARE: DR. LILIA IDANAN MD

MEDICARE: DR. LILIA IDANAN MD
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
1207R00000XInternal Medicine Physician184732NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12591372OTHERNYGHI
2289030201OTHERNYHEALTH PLUS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41112538OTHERNYHEALTH FIRST
5450538OTHERNYAMERIHEALTH
6P2457769OTHERNYOXFORD
7177179OTHERNYELDER PLAN
8184732POTHERNYHEALTHCARE PARTNERS IPA
9226AY1OTHERNYBCBS

General Provider Information

NPI Number : 1871503946
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LILIA IDANAN MD
Provider Business Mailing Address
First Line : 153 CRESCENT DR
Second Line :
City : ALBERTSON
State : NY
Zip : 11507-1103
Country : US
Telephone Number : 212-255-2333
Fax Number : 212-255-2455
Provider Business Practice Location Address
First Line : 255 WARNER AVE
Second Line :
City : ROSLYN HEIGHTS
State : NY
Zip : 11577-1000
Country : US
Telephone Number : 516-621-7662
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/16/2008

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