Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 273720 | NY |
NPI | 1265751002 |
---|---|
Provider Name | Dr. Simon Li |
First Address | Brooklyn, NY 11214 |
Second Address | Brooklyn, NY 11214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 30/08/2018 |