Provider Demographics
NPI:1326134073
Name:HARVEY, LILIIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LILIIAN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:HARVEY
Other - Last Name:BANCHIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11 GATEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-829-1853
Mailing Address - Fax:516-829-1853
Practice Address - Street 1:560 NORTHERN BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-466-5166
Practice Address - Fax:516-466-7828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03E671Medicare ID - Type Unspecified