Individual
LILY PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
225 WILLIAMSON ST, ELIZABETH, NJ 07202
(908) 994-5204
Mailing address
572 WESTMINSTER AVE, ELIZABETH, NJ 07208-2207
(480) 332-9734
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA10316400
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2014
Last updated
08/23/2018
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