Individual
JESSICA LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
256 MASON AVE # C, STATEN ISLAND, NY 10305-3408
(718) 226-1251
Mailing address
256 MASON AVE # C, STATEN ISLAND, NY 10305-3408
(914) 262-8642
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
063943
NY
Other
Enumeration date
04/09/2020
Last updated
08/18/2025
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