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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

EVERGREEN VITALITY PRIMARY CARE PC
NPI 1053244384
Clinic/Center - Primary Care in Hartsdale, NY

Active since June 05, 2026CLIA 33D2347932 · Waiver
280 N CENTRAL AVE STE 312, HARTSDALE, NY 10530(914) 439-2690(351) 200-1199 Get Directions Write a Review

NPPES record last updated: September 2, 2026. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Sep 2, 2026, Aug 6, 2026, Jun 5, 2026 (3 updates tracked since 2026).

About Evergreen Vitality Primary Care Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN VITALITY PRIMARY CARE PC (NPI 1053244384) is a healthcare organization registered as a primary care in Hartsdale, New York and active in the NPI registry since June 2026. The organization holds a CLIA Waiver certificate valid through July 27, 2028 and lists Changqing Li, President, as its authorized official.

NPPES Registry Identity

NPI1053244384
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameEVERGREEN VITALITY PRIMARY CARE PC
Location Address280 N CENTRAL AVE STE 312Hartsdale, NY 10530-1839
Mailing Address280 N Central Ave Ste 312Hartsdale, NY 10530-1839 · (914) 439-2690 · Fax (351) 200-1199
Phone(914) 439-2690
Fax(351) 200-1199
Organization SubpartNo
Authorized OfficialChangqing LiPresident · (347) 387-3954
Enumeration DateJune 5, 2026
Last NPPES UpdateSeptember 2, 20263 updates tracked since enumeration
NPPES CertifiedSeptember 2, 2026
✔ NPI 1053244384 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
Also ListedInternal MedicineTaxonomy 207R00000X
280 N CENTRAL AVE STE 312, Hartsdale, NY 10530
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D2347932

Evergreen Vitality Primary Care · Hartsdale, NY
Active · expires Jul 27, 2028
CLIA Number33D2347932
Laboratory TypePhysician Office
Certificate Effective DateJuly 28, 2026
Certificate Expiration DateJuly 27, 2028
Laboratory DirectorChangqing Li
Laboratory Phone(347) 387-3954
Laboratory LocationEvergreen Vitality Primary Care280 N Central Ave Ste 312, Hartsdale, NY 10530
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHANGQING LI MD
Internal Medicine
280 N CENTRAL AVE STE 312
HARTSDALE, NY 10530
Westchester County (914) 439-2690

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Vitality Primary Care PC's NPI number?

The NPI number for Evergreen Vitality Primary Care PC is 1053244384. It was assigned to this organization in the NPPES registry on June 5, 2026.

Where is Evergreen Vitality Primary Care PC located?

Evergreen Vitality Primary Care PC is located at 280 N Central Ave Ste 312, Hartsdale, NY 10530. The listed phone number is (914) 439-2690.

What is Evergreen Vitality Primary Care PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Evergreen Vitality Primary Care PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2347932) is associated with this NPI, valid through July 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Evergreen Vitality Primary Care PC was last updated on September 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.