Healthcare Provider Details

I. General information

NPI: 1487814893
Provider Name (Legal Business Name): JIANYI LI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR DEPT. OF PATHOLOGY, NORTH SHORE UNIVERSITY HOSPITAL
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

621 S 10TH ST
NEW HYDE PARK NY
11040-5556
US

V. Phone/Fax

Practice location:
  • Phone: 832-721-7855
  • Fax:
Mailing address:
  • Phone: 516-562-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number23920
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number250013
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: