Provider Demographics
NPI:1780827113
Name:ISTOMINA, LILIYA A (MSN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LILIYA
Middle Name:A
Last Name:ISTOMINA
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6501
Mailing Address - Country:US
Mailing Address - Phone:212-695-5122
Mailing Address - Fax:212-695-2260
Practice Address - Street 1:1797 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6501
Practice Address - Country:US
Practice Address - Phone:212-695-5122
Practice Address - Fax:212-695-2260
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily