Provider Demographics
NPI:1871628123
Name:ALBUM, LIA M (CPNP)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:M
Last Name:ALBUM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 HERKIMER AVE
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1115
Mailing Address - Country:US
Mailing Address - Phone:201-439-1121
Mailing Address - Fax:
Practice Address - Street 1:620 COLUMBUS AVE
Practice Address - Street 2:STE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1458
Practice Address - Country:US
Practice Address - Phone:212-874-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF 381573-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF 381573-1OtherLICENSE