Provider Demographics
NPI:1740543966
Name:PIRES, LILIANA FERNANDES
Entity type:Individual
Prefix:MISS
First Name:LILIANA
Middle Name:FERNANDES
Last Name:PIRES
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 1:63 MCGEORY AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1890 PALMER AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3059
Practice Address - Country:US
Practice Address - Phone:914-833-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328627091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist