=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922143759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LILY W ENG OLIVER, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 12/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 LAFAYETTE ST FL 9
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-233-5153
-----------------------------------------------------
Fax | 212-842-8042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 LAFAYETTE ST FL 9
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-233-5153
-----------------------------------------------------
Fax | 212-842-5300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. LILY W ENG
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 212-233-5153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 045279
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------