Provider Demographics
NPI:1013006154
Name:LILLY, REGINA ZVITKOVITZ (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ZVITKOVITZ
Last Name:LILLY
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 1:418 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1070
Mailing Address - Country:US
Mailing Address - Phone:315-787-4000
Mailing Address - Fax:315-536-0430
Practice Address - Street 1:418 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1070
Practice Address - Country:US
Practice Address - Phone:315-787-4000
Practice Address - Fax:315-536-0430
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219816207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2108056Medicaid
NY2589769OtherGHI
NYP010219816OtherBLUE CHOICE
NY219816-6OtherWORKER'S COMP
NYP010219816OtherBLUE SHIELD
NY16832BJOtherPREFERRED CARE
NY2589769OtherGHI