Provider Demographics
NPI:1083671549
Name:LI, DENA Y (MD)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:Y
Last Name:LI
Suffix:
Gender:F
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:F1 BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3337
Mailing Address - Country:US
Mailing Address - Phone:732-603-0055
Mailing Address - Fax:732-603-8228
Practice Address - Street 1:F1 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3337
Practice Address - Country:US
Practice Address - Phone:732-603-0055
Practice Address - Fax:732-603-8228
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH07367Medicare UPIN
NJ033103Medicare ID - Type Unspecified