Provider Demographics
NPI:1548899883
Name:ORTHOPEDIC LI, P.C.
Entity type:Organization
Organization Name:ORTHOPEDIC LI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DETORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-358-1868
Mailing Address - Street 1:403 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2356
Mailing Address - Country:US
Mailing Address - Phone:631-661-2663
Mailing Address - Fax:631-321-4971
Practice Address - Street 1:403 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2356
Practice Address - Country:US
Practice Address - Phone:631-661-2663
Practice Address - Fax:631-321-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty