Provider Demographics
NPI:1316295413
Name:POPOVETSKY, LILYA (SPED)
Entity type:Individual
Prefix:
First Name:LILYA
Middle Name:
Last Name:POPOVETSKY
Suffix:
Gender:F
Credentials:SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3669
Mailing Address - Country:US
Mailing Address - Phone:516-730-5001
Mailing Address - Fax:
Practice Address - Street 1:445 BROADHOLLOW RD
Practice Address - Street 2:SUITE 25
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3669
Practice Address - Country:US
Practice Address - Phone:516-730-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor