Basic Information
| Provider Information | |||||||||
| NPI: | 1750643003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERMENO | ||||||||
| FirstName: | LILIANA | ||||||||
| MiddleName: | PATRICIA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | TSHH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070102304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178435416 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2510 WESTCHESTER AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104613512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185975558 | ||||||||
| FaxNumber: | 7188235494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2012 | ||||||||
| LastUpdateDate: | 06/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PROVISIONAL TSHH | NY | Y | Other Service Providers | Specialist |
No ID Information.