Provider Demographics
NPI:1003692971
Name:VARDINA, LILIT (PHYSICAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LILIT
Middle Name:
Last Name:VARDINA
Suffix:
Gender:F
Credentials:PHYSICAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 HOMECREST AVE APT 3J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4533
Mailing Address - Country:US
Mailing Address - Phone:347-841-3408
Mailing Address - Fax:
Practice Address - Street 1:2665 HOMECREST AVE APT 3J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4533
Practice Address - Country:US
Practice Address - Phone:347-841-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant