Healthcare Provider Details

I. General information

NPI: 1245918564
Provider Name (Legal Business Name): KORAL LIRIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 10/30/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 WESTCHESTER AVE
BRONX NY
10459-3204
US

IV. Provider business mailing address

60 MADISON AVE
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-320-4466
  • Fax: 718-991-3829
Mailing address:
  • Phone: 212-545-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404730-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: