Provider Demographics
NPI:1124195508
Name:LI, LILLIAN T (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:T
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 BROADWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3910
Mailing Address - Country:US
Mailing Address - Phone:212-732-9773
Mailing Address - Fax:212-732-0847
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3910
Practice Address - Country:US
Practice Address - Phone:212-732-9773
Practice Address - Fax:212-732-0847
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY145702207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50A401Medicare ID - Type Unspecified
B15537Medicare UPIN