Provider Demographics
NPI:1871560409
Name:LI, SIMON (MD)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HETTIEFRED RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-3205
Mailing Address - Country:US
Mailing Address - Phone:203-939-8287
Mailing Address - Fax:888-323-3083
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL RM 328
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:203-939-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10844000207R00000X, 208000000X, 2080P0203X
CT046079208000000X
MA223798208D00000X
NY257559-1282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282NC2000XHospitalsGeneral Acute Care HospitalChildren