Provider Demographics
NPI:1104013648
Name:LI, TIMOTHY (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 GLEN HEAD RD
Mailing Address - Street 2:STE 150
Mailing Address - City:OLD BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11545
Mailing Address - Country:US
Mailing Address - Phone:516-609-2848
Mailing Address - Fax:516-609-2908
Practice Address - Street 1:333 GLEN HEAD RD
Practice Address - Street 2:STE 150
Practice Address - City:OLD BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-609-2848
Practice Address - Fax:516-609-2908
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0011551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist