Provider Demographics
NPI:1891991147
Name:PARASKEVAS, LILLY-ROSE (MD)
Entity Type:Individual
Prefix:
First Name:LILLY-ROSE
Middle Name:
Last Name:PARASKEVAS
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 1:30-16 30TH DRIVE
Mailing Address - Street 2:MEZZANINE
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1874
Mailing Address - Country:US
Mailing Address - Phone:718-728-3376
Mailing Address - Fax:917-210-6667
Practice Address - Street 1:30-16 30TH DR
Practice Address - Street 2:MEZZANINE
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:718-728-3376
Practice Address - Fax:917-210-6667
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243252207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400007506Medicare PIN