Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 254956 | NY |
NPI | 1023034345 |
---|---|
Provider Name | Dr. Ellen Li |
First Address | East Setauket, NY 11733-4064 |
Second Address | East Setauket, NY 11733-4064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 09/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202278404 | (05) | MO |
A27658 | (02) |