Individual
IVAN LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
214 INDIAN HEAD RD, COMMACK, NY 11725-1310
(917) 607-3818
Mailing address
214 INDIAN HEAD RD, COMMACK, NY 11725-1310
(917) 607-3818
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
311752
NY
Other
Enumeration date
04/05/2024
Last updated
04/05/2024
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