Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2182 | WV |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 234144 | NY |
NPI | 1447367685 |
---|---|
Provider Name | To Shan Li |
First Address | Old Westbury, NY 11568-8000 |
Second Address | Old Westbury, NY 11568-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 21/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810006150 | (05) | WV |
H81448 | (02) |