Healthcare Provider Details

I. General information

NPI: 1790289114
Provider Name (Legal Business Name): SUE LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE # E4E10
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

451 CLARKSON AVE # E4E10
BROOKLYN NY
11203-2054
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-7801
  • Fax:
Mailing address:
  • Phone: 718-245-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number337248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: