Provider Demographics
NPI:1104375229
Name:ROBINSON, LIANA (TRICHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:TRICHOLOGIST
Other - Prefix:
Other - First Name:LIANA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRICHOLOGIST
Mailing Address - Street 1:8471 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2543
Mailing Address - Country:US
Mailing Address - Phone:718-657-5941
Mailing Address - Fax:
Practice Address - Street 1:8471 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2543
Practice Address - Country:US
Practice Address - Phone:718-657-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5794781744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management