Individual
IDA LI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
475 SEAVIEW AVE # 2261548, STATEN ISLAND, NY 10305-3436
(718) 226-1548
(718) 226-8447
Mailing address
80 BAY STREET LNDG APT 5L, STATEN ISLAND, NY 10301-2548
(917) 607-8589
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
295551
NY
Other
Enumeration date
04/26/2016
Last updated
01/25/2019
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