Provider Demographics
NPI:1093209280
Name:L&L MEDICAL CARE PC
Entity Type:Organization
Organization Name:L&L MEDICAL CARE PC
Other - Org Name:L&L MEDICALCARE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YIDING
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-851-8928
Mailing Address - Street 1:5115 7TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2806
Mailing Address - Country:US
Mailing Address - Phone:718-851-8928
Mailing Address - Fax:718-851-0618
Practice Address - Street 1:5115 7TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2806
Practice Address - Country:US
Practice Address - Phone:718-851-8928
Practice Address - Fax:718-851-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03099254Medicaid