Provider Demographics
NPI:1871503946
Name:IDANAN, LILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LILIA
Middle Name:
Last Name:IDANAN
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 1:153 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1103
Mailing Address - Country:US
Mailing Address - Phone:212-255-2333
Mailing Address - Fax:212-255-2455
Practice Address - Street 1:255 WARNER AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1000
Practice Address - Country:US
Practice Address - Phone:516-621-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2591372OtherGHI
NY289030201OtherHEALTH PLUS
NY01922334Medicaid
NY1112538OtherHEALTH FIRST
NY450538OtherAMERIHEALTH
NYP2457769OtherOXFORD
NY177179OtherELDER PLAN
NY184732POtherHEALTHCARE PARTNERS IPA
NY226AY1OtherBCBS
NY177179OtherELDER PLAN
NY184732POtherHEALTHCARE PARTNERS IPA