Healthcare Provider Details

I. General information

NPI: 1497685507
Provider Name (Legal Business Name): LILI RUAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 7TH AVE
BROOKLYN NY
11220-3964
US

IV. Provider business mailing address

2136 E 24TH ST
BROOKLYN NY
11229-4902
US

V. Phone/Fax

Practice location:
  • Phone: 917-868-0628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: