Provider Demographics
NPI:1588744130
Name:LI, WING C (PA)
Entity type:Individual
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First Name:WING
Middle Name:C
Last Name:LI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:114 FERNDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1925
Mailing Address - Country:US
Mailing Address - Phone:718-920-5462
Mailing Address - Fax:718-653-5073
Practice Address - Street 1:MMC -DEPT OF CT SURGERY
Practice Address - Street 2:111 EAST 210TH STREET
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-01-10
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Provider Licenses
StateLicense IDTaxonomies
NY011409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant