Healthcare Provider Details

I. General information

NPI: 1134071749
Provider Name (Legal Business Name): IVY LI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W 57TH ST APT 103
NEW YORK NY
10019-3122
US

IV. Provider business mailing address

9 NORTHGATE PARK
RINGWOOD NJ
07456-2129
US

V. Phone/Fax

Practice location:
  • Phone: 917-560-7538
  • Fax:
Mailing address:
  • Phone: 973-356-6019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007885
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: