Provider Demographics
NPI:1689908170
Name:LIBANAN, LILIMAE (PT)
Entity Type:Individual
Prefix:
First Name:LILIMAE
Middle Name:
Last Name:LIBANAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 HENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1441
Mailing Address - Country:US
Mailing Address - Phone:201-261-8323
Mailing Address - Fax:
Practice Address - Street 1:554 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2003
Practice Address - Country:US
Practice Address - Phone:212-740-5157
Practice Address - Fax:212-740-8566
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014162-1225100000X
NJ40QA01123200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist