Provider Demographics
NPI:1609228576
Name:PRADHANANG, LILIBETH S
Entity Type:Individual
Prefix:MRS
First Name:LILIBETH
Middle Name:S
Last Name:PRADHANANG
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LILIBETH
Other - Middle Name:SEMBRANO
Other - Last Name:PRADHANANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN-C
Mailing Address - Street 1:50 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2106
Mailing Address - Country:US
Mailing Address - Phone:201-414-7423
Mailing Address - Fax:
Practice Address - Street 1:714 10TH ST
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2921
Practice Address - Country:US
Practice Address - Phone:551-257-7038
Practice Address - Fax:201-552-2358
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00639800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology