MEDICARE: DR. LIANE DELIGDISCH MD

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
1	207ZP0101X	Anatomic Pathology Physician	135202	NY

General Provider Information

NPI Number	:	1780682708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIANE DELIGDISCH MD

Provider Business Mailing Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	PATHOLOGY, BOX 1194
City	:	NEW YORK
State	:	NY
Zip	:	10029-6500
Country	:	US
Telephone Number	:	212-241-9114
Fax Number	:	212-534-7491

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	PATHOLOGY, ANNENBERG 15-92
City	:	NEW YORK
State	:	NY
Zip	:	10029-6500
Country	:	US
Telephone Number	:	212-241-9114
Fax Number	:	212-534-7491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/29/2011

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