Provider Demographics
NPI:1366704264
Name:FARBEROVA, LILIYA
Entity type:Individual
Prefix:MRS
First Name:LILIYA
Middle Name:
Last Name:FARBEROVA
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 1:425 NEPTUNE AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4548
Mailing Address - Country:US
Mailing Address - Phone:917-776-6739
Mailing Address - Fax:
Practice Address - Street 1:425 NEPTUNE AVE APT 6D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4548
Practice Address - Country:US
Practice Address - Phone:917-776-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1107468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1107468Medicaid