Provider Demographics
NPI:1922544451
Name:LI, MANLI
Entity Type:Individual
Prefix:
First Name:MANLI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 FORT HAMILTON PKWY
Mailing Address - Street 2:APT 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1137
Mailing Address - Country:US
Mailing Address - Phone:646-726-0892
Mailing Address - Fax:
Practice Address - Street 1:7110 FORT HAMILTON PKWY
Practice Address - Street 2:APT 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1137
Practice Address - Country:US
Practice Address - Phone:646-726-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist