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NPI Code Detail

MEDICARE: LILY D FREED

MEDICARE: LILY D FREED
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1215790696
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILY D FREED
Provider Business Mailing Address
First Line : 1815 215TH ST
Second Line :
City : BAYSIDE
State : NY
Zip : 11360-2154
Country : US
Telephone Number : 917-873-9533
Fax Number :
Provider Business Practice Location Address
First Line : 7000 AUSTIN ST STE 200
Second Line :
City : FOREST HILLS
State : NY
Zip : 11375-4739
Country : US
Telephone Number : 718-762-7633
Fax Number : 718-886-8694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2024
Last Update Date : 01/30/2024

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Directions to “ LILY D FREED ” Practice Location

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