Provider Demographics
NPI:1083878623
Name:MACK, LIAN ALANA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIAN
Middle Name:ALANA
Last Name:MACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIAN
Other - Middle Name:ALANA
Other - Last Name:SORHAINDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:15TH & 16TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:212-247-8100
Mailing Address - Fax:
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:15TH & 16TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245368207N00000X
NJ25MA08808000207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology