Healthcare Provider Details

I. General information

NPI: 1447367685
Provider Name (Legal Business Name): TO SHAN LI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHERN BLVD ACADEMIC HEALTH CARE CENTER, NYCOM-NYIT
OLD WESTBURY NY
11568-8000
US

IV. Provider business mailing address

P.O. BOX 8000 ACADEMIC HEALTH CARE CENTER, NYCOM-NYIT, NORTHERN BLVD
OLD WESTBURY NY
11568-8000
US

V. Phone/Fax

Practice location:
  • Phone: 516-686-3700
  • Fax:
Mailing address:
  • Phone: 516-686-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2182
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number234144
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: