Provider Demographics
NPI:1235452434
Name:KOSTANDY, LILIAN
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:KOSTANDY
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 1:65 EASTERN WAY
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2139
Mailing Address - Country:US
Mailing Address - Phone:201-925-1563
Mailing Address - Fax:
Practice Address - Street 1:33 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6602
Practice Address - Country:US
Practice Address - Phone:212-741-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist