Provider Demographics
NPI:1093886475
Name:BERDICHEVSKY, LILLIAN (MD)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:BERDICHEVSKY
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 1:1084 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1107
Mailing Address - Country:US
Mailing Address - Phone:914-848-8640
Mailing Address - Fax:914-848-8641
Practice Address - Street 1:1022 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1303
Practice Address - Country:US
Practice Address - Phone:914-848-8640
Practice Address - Fax:914-848-8641
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology