Provider Demographics
NPI:1417228610
Name:KANYOOSKY, LILI (RN)
Entity Type:Individual
Prefix:MISS
First Name:LILI
Middle Name:
Last Name:KANYOOSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 OXFORD PL APT B
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-5536
Mailing Address - Country:US
Mailing Address - Phone:929-352-9323
Mailing Address - Fax:
Practice Address - Street 1:1509 OXFORD PL APT B
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-5536
Practice Address - Country:US
Practice Address - Phone:929-352-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641320-1163W00000X
NY641320163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse