Individual
DR. LILIANA TIQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2701 SUNRISE HWY, ISLIP TERRACE, NY 11752-2612
(631) 581-9330
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
219602
NY
208000000X
Pediatrics Physician
Primary
219602
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02379995
—
NY
01
—
508Y31
EMPIRE BC.BS
NY
01
—
7740538
AETNA
NY
Enumeration date
06/02/2006
Last updated
09/11/2017
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