Healthcare Provider Details

I. General information

NPI: 1063114197
Provider Name (Legal Business Name): TAI LAI LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 60TH ST STE 1
BROOKLYN NY
11220-5490
US

IV. Provider business mailing address

366 5TH AVE FL 4
NEW YORK NY
10001-2241
US

V. Phone/Fax

Practice location:
  • Phone: 718-567-8899
  • Fax: 718-765-0383
Mailing address:
  • Phone: 718-567-8899
  • Fax: 718-765-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number343366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: