Healthcare Provider Details

I. General information

NPI: 1588589972
Provider Name (Legal Business Name): LILI J MULLANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CRYSTAL RUN RD STE 203
MIDDLETOWN NY
10941-7104
US

IV. Provider business mailing address

100 HILLSIDE DR APT F5
MIDDLETOWN NY
10941-1358
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax:
Mailing address:
  • Phone: 646-651-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: