Healthcare Provider Details

I. General information

NPI: 1285951590
Provider Name (Legal Business Name): LINDA T LI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/20/2023
Certification Date: 10/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST FL 14
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

5 E 98TH ST FL 14
NEW YORK NY
10029-6501
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-1608
  • Fax:
Mailing address:
  • Phone: 212-241-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10034424
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberP0428
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number25MA11628100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number92806
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number320379
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: