Healthcare Provider Details

I. General information

NPI: 1265751002
Provider Name (Legal Business Name): SIMON LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 19TH AVE
BROOKLYN NY
11214
US

IV. Provider business mailing address

8510 19TH AVE
BROOKLYN NY
11214
US

V. Phone/Fax

Practice location:
  • Phone: 347-562-3285
  • Fax: 718-232-8808
Mailing address:
  • Phone: 347-562-3285
  • Fax: 718-232-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number273720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: