Provider Demographics
NPI:1558617878
Name:LI, JANE (SPECIAL ED TEACHER)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 AVENUE V
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4321
Mailing Address - Country:US
Mailing Address - Phone:646-920-6229
Mailing Address - Fax:
Practice Address - Street 1:1322 AVENUE V
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4321
Practice Address - Country:US
Practice Address - Phone:646-920-6229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY850378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist