Provider Demographics
NPI:1386973055
Name:MASTRONARDI, LILY
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:MASTRONARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:YEONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:127 ROCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5357
Mailing Address - Country:US
Mailing Address - Phone:845-352-6729
Mailing Address - Fax:
Practice Address - Street 1:600 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5419
Practice Address - Country:US
Practice Address - Phone:973-422-0110
Practice Address - Fax:973-740-9007
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09075700314000000X
NY001008314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility