Provider Demographics
NPI:1902301997
Name:SANFORD NP IN ADULT HEALTH PC
Entity Type:Organization
Organization Name:SANFORD NP IN ADULT HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-220-3234
Mailing Address - Street 1:9148 GOLD RD
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2417
Mailing Address - Country:US
Mailing Address - Phone:646-220-3234
Mailing Address - Fax:
Practice Address - Street 1:14454 SANFORD AVE APT 18
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1620
Practice Address - Country:US
Practice Address - Phone:646-220-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307053-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center