Active NPI
Teresa Marie Lilly, NP
- Nurse Practitioner
- Rochester, NY
National Provider Identifier
1902834724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 400331
- Practice address
- 300 Crittenden Blvd
Rochester, NY 14642-0001 - Phone
- (585) 275-6733
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 400331 | NY | Primary |
Addresses
Primary practice location
300 Crittenden Blvd
Rochester, NY 14642-0001
Mailing address
300 Crittenden Blvd
Rochester, NY 14642-0001
Phone (585) 275-6733
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01921975 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 400331 | NY | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902834724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 CRITTENDEN BLVD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146420001",
"telephone_number": "585-275-6733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 CRITTENDEN BLVD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146420001",
"telephone_number": "585-275-6733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLY",
"first_name": "TERESA",
"middle_name": "MARIE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NY",
"license": "400331",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01921975",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.