Provider Demographics
NPI:1174807119
Name:LI, NATHAN CHRISTOPHER (PA-C)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:CHRISTOPHER
Last Name:LI
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:129 W 29TH ST FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5105
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:408 W 14TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1042
Practice Address - Country:US
Practice Address - Phone:212-530-0639
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2023-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA60573363AM0700X
IL085.008101363AM0700X
MAPA8445363AM0700X
NY015497363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical