Provider Demographics
NPI:1396798443
Name:YEN, LILY C (PT)
Entity type:Individual
Prefix:MS
First Name:LILY
Middle Name:C
Last Name:YEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 209TH PL
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2425
Mailing Address - Country:US
Mailing Address - Phone:718-229-5387
Mailing Address - Fax:
Practice Address - Street 1:2842 209TH PL
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2425
Practice Address - Country:US
Practice Address - Phone:718-229-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02692831Medicaid
NY07525GMedicare ID - Type Unspecified
NYQ16066Medicare UPIN