Provider Demographics
NPI:1720460108
Name:KORDIE, LILIAN
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:KORDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 EVERGREEN PL STE 1B
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2007
Mailing Address - Country:US
Mailing Address - Phone:201-407-0702
Mailing Address - Fax:973-210-4430
Practice Address - Street 1:137 EVERGREEN PL STE 1B
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2007
Practice Address - Country:US
Practice Address - Phone:201-407-0702
Practice Address - Fax:973-210-4430
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00546300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily