| Simon Li Medical PLLC | |
|
8510 19th Ave Brooklyn NY 11214-3106 | |
| (347) 562-3285 | |
| (718) 232-8808 |
| Full Name | Simon Li Medical PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 8510 19th Ave, Brooklyn, New York |
| Authorized Official Name and Position | Simon Li (MD/PRESIDENT) |
| Authorized Official Contact | 3475623285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Simon Li Medical PLLC 8510 19th Ave Brooklyn NY 11214-3106 Ph: (347) 562-3285 | Simon Li Medical PLLC 8510 19th Ave Brooklyn NY 11214-3106 Ph: (347) 562-3285 |
| NPI Number | 1952887580 |
|---|---|
| Provider Enumeration Date | 07/17/2018 |
| Last Update Date | 07/17/2018 |
| Medicare PECOS PAC ID | 5092067827 |
|---|---|
| Medicare Enrollment ID | O20181005002233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952887580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Simon Li |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265751002 PECOS PAC ID: 6901127596 Enrollment ID: I20150608002467 |
| Provider Name | Dandan Guan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1629465158 PECOS PAC ID: 0648716803 Enrollment ID: I20240910002067 |
| Provider Name | Ivan Li |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295587798 PECOS PAC ID: 3870031008 Enrollment ID: I20241014000461 |
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