Provider Demographics
NPI:1205984218
Name:NASH, LILLIAN DOROTHY (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:DOROTHY
Last Name:NASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:330 W 58TH ST
Mailing Address - Street 2:SUITE 613
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1827
Mailing Address - Country:US
Mailing Address - Phone:212-247-3111
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST
Practice Address - Street 2:SUITE 613
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1827
Practice Address - Country:US
Practice Address - Phone:212-247-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083889-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09422Medicare UPIN