Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 231795 | NY |
Y | 111NI0900X | Internist | 231795 | NY |
N | 207U00000X | Nuclear Medicine Specialist | 231795 | NY |
NPI | 1669564886 |
---|---|
Provider Name | Tong Li |
First Address | Woodmere, NY 11598-2161 |
Second Address | Woodmere, NY 11598-2161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 25/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03111662 | (05) | NY |