Provider Demographics
NPI:1134308919
Name:LI REHABILITATION MEDICINE, PC
Entity Type:Organization
Organization Name:LI REHABILITATION MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONGLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-360-7380
Mailing Address - Street 1:8 DELAMAR CT
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1792
Mailing Address - Country:US
Mailing Address - Phone:631-360-7380
Mailing Address - Fax:
Practice Address - Street 1:261 SMITHTOWN BLVD STE 1
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2089
Practice Address - Country:US
Practice Address - Phone:631-360-7380
Practice Address - Fax:631-360-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
NY229151261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08280Medicare PIN