Provider Demographics
NPI:1083723043
Name:EL-KASSIS, LILIANE S (MD)
Entity Type:Individual
Prefix:
First Name:LILIANE
Middle Name:S
Last Name:EL-KASSIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILIANE
Other - Middle Name:S
Other - Last Name:KASSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:30 HARRISON STREET
Practice Address - Street 2:SUITE 340
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2162
Practice Address - Country:US
Practice Address - Phone:607-763-8088
Practice Address - Fax:607-729-4452
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252033207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02828568Medicaid
NYRB1829Medicare PIN