Provider Demographics
NPI:1225761604
Name:PETRYCHUK, LILIYA
Entity Type:Individual
Prefix:
First Name:LILIYA
Middle Name:
Last Name:PETRYCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 E 22ND ST APT 104
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1541
Mailing Address - Country:US
Mailing Address - Phone:347-403-8399
Mailing Address - Fax:
Practice Address - Street 1:1680 E 22ND ST APT 104
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1541
Practice Address - Country:US
Practice Address - Phone:347-403-8399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist