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General NPI Number Information
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NPI Number | 1902301997
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Entity Type | Organization
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Legal Business Name | SANFORD NP IN ADULT HEALTH PC
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 14454 SANFORD AVE APT 18
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City | FLUSHING
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State | NY
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Zip | 11355-1620
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Country | US
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Telephone | 646-220-3234
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Fax |
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Provider Business Mailing Address
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Address Line | 9148 GOLD RD
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City | OZONE PARK
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State | NY
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Zip | 11417-2417
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Country | US
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Telephone | 646-220-3234
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Fax |
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Authorized Official
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Title or Position | CHIEF OFFICER
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Name | RONG LI
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Credential | NP
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Telephone | 646-220-3234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 307053-1
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License Number State | NY
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