Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Evergreen Vitality Primary Care PC

Organization Internal Medicine Physician · NPI 1053244384

Evergreen Vitality Primary Care PC provides Internal Medicine Physician services in Hartsdale, New York. Registered with an NPI since 2026.

In the registry since
2026
Specialties on file
2
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

280 N Central Ave Ste 312
Hartsdale, NY 10530-1839
Phone: (914) 439-2690
Fax: (351) 200-1199
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X
Internal Medicine Physician Taxonomy 207R00000X

Record details

NPI number1053244384
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Changqing Li — President · (347) 387-3954
NPI enumeratedJune 5, 2026
Last updated in NPPESSeptember 2, 2026
Certification dateSeptember 2, 2026
Mailing address280 N Central Ave Ste 312, Hartsdale, NY 10530-1839

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