Provider Demographics
NPI:1497202618
Name:LIYIM, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:LIYIM
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 1:19 SCHNEIDER AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10928-1932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-5906
Practice Address - Country:US
Practice Address - Phone:845-267-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist