Provider Demographics
NPI:1073584017
Name:LILLY, SARAH C (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:C
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 1:927 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0250
Mailing Address - Country:US
Mailing Address - Phone:212-348-6000
Mailing Address - Fax:212-879-0149
Practice Address - Street 1:927 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0250
Practice Address - Country:US
Practice Address - Phone:212-348-6000
Practice Address - Fax:212-879-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010SU1Medicare ID - Type Unspecified
H82741Medicare UPIN