Healthcare Provider Details

I. General information

NPI: 1699485706
Provider Name (Legal Business Name): LIORA AMINOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 1530
FOREST HILLS NY
11375-7252
US

IV. Provider business mailing address

11835 QUEENS BLVD STE 1530
FOREST HILLS NY
11375-7252
US

V. Phone/Fax

Practice location:
  • Phone: 718-651-7770
  • Fax:
Mailing address:
  • Phone: 718-651-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: