1447367685 NPI number — TO SHAN LI DO

Table of content: TO SHAN LI DO (NPI 1447367685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447367685 NPI number — TO SHAN LI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
TO
Provider Middle Name:
SHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447367685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 8000
Provider Second Line Business Mailing Address:
ACADEMIC HEALTH CARE CENTER, NYCOM-NYIT, NORTHERN BLVD
Provider Business Mailing Address City Name:
OLD WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11568-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-686-3700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NORTHERN BLVD
Provider Second Line Business Practice Location Address:
ACADEMIC HEALTH CARE CENTER, NYCOM-NYIT
Provider Business Practice Location Address City Name:
OLD WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11568-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-686-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  2182 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X , with the licence number: 234144 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810006150 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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