Provider Demographics
NPI:1003011982
Name:DEEB, LILIANE SARKIS (MD)
Entity Type:Individual
Prefix:
First Name:LILIANE
Middle Name:SARKIS
Last Name:DEEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ELKHART ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1606
Mailing Address - Country:US
Mailing Address - Phone:848-219-3417
Mailing Address - Fax:
Practice Address - Street 1:4106 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3335
Practice Address - Country:US
Practice Address - Phone:718-226-7855
Practice Address - Fax:718-227-5814
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255895207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03487010Medicaid
NY03487010Medicaid