Provider Demographics
NPI:1013291293
Name:LIONDALE MANAGEMENT INC
Entity Type:Organization
Organization Name:LIONDALE MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LIONELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSOON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-579-9136
Mailing Address - Street 1:10 W 74TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2404
Mailing Address - Country:US
Mailing Address - Phone:212-579-9136
Mailing Address - Fax:212-579-6917
Practice Address - Street 1:10 W 74TH ST APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2404
Practice Address - Country:US
Practice Address - Phone:212-579-9136
Practice Address - Fax:212-579-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193423208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty