Provider Demographics
NPI:1851329411
Name:YANOVSKAYA, LILIYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LILIYA
Middle Name:
Last Name:YANOVSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 PLEASANT VALLEY WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2988
Mailing Address - Country:US
Mailing Address - Phone:973-731-9707
Mailing Address - Fax:973-731-9709
Practice Address - Street 1:412 PLEASANT VALLEY WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2988
Practice Address - Country:US
Practice Address - Phone:973-731-9707
Practice Address - Fax:973-731-9709
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06715400207RC0000X, 207UN0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8271101Medicaid
NJH35636Medicare UPIN
NJ089045Medicare ID - Type Unspecified