Provider Demographics
NPI:1750643003
Name:CERMENO, LILIANA PATRICIA (TSHH)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:PATRICIA
Last Name:CERMENO
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-2304
Mailing Address - Country:US
Mailing Address - Phone:917-843-5416
Mailing Address - Fax:
Practice Address - Street 1:2510 WESTCHESTER AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3512
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:718-823-5494
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPROVISIONAL TSHH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist