Provider Demographics
NPI:1578660304
Name:LI, YAN (MD)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5535
Mailing Address - Country:US
Mailing Address - Phone:914-631-2896
Mailing Address - Fax:914-631-0094
Practice Address - Street 1:150 WHITE PLAINS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5535
Practice Address - Country:US
Practice Address - Phone:914-631-2896
Practice Address - Fax:914-631-0094
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223759207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY689Q51OtherBLUE CROSS BLUE SHIELD
NY02758450Medicaid
NY689Q51OtherBLUE CROSS BLUE SHIELD
NYI68172Medicare UPIN