Provider Demographics
NPI:1174510408
Name:WEINSTEIN, LILY (MD)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LILYA
Other - Middle Name:
Other - Last Name:VAYNSHTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1379 54TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4259
Mailing Address - Country:US
Mailing Address - Phone:718-436-1600
Mailing Address - Fax:718-436-2085
Practice Address - Street 1:1379 54TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4259
Practice Address - Country:US
Practice Address - Phone:718-436-1600
Practice Address - Fax:718-436-2085
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02129633Medicaid
NYP2498281OtherOXFORD
NY8C3221Medicare ID - Type Unspecified
NYH27631Medicare UPIN