Provider Demographics
NPI:1336170273
Name:EPEL, LIDIA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:M
Last Name:EPEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 NORTH VILLAGE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-766-6430
Mailing Address - Fax:516-766-5139
Practice Address - Street 1:165 NORTH VILLAGE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-766-6430
Practice Address - Fax:516-766-5139
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29774208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice