Provider Demographics
NPI:1417244302
Name:LILI REN, M.D.,P.C.
Entity Type:Organization
Organization Name:LILI REN, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LILI
Authorized Official - Middle Name:
Authorized Official - Last Name:REN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-5253
Mailing Address - Street 1:13421 MAPLE AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4527
Mailing Address - Country:US
Mailing Address - Phone:718-886-5253
Mailing Address - Fax:718-313-0248
Practice Address - Street 1:13421 MAPLE AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4527
Practice Address - Country:US
Practice Address - Phone:718-886-5253
Practice Address - Fax:718-313-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254738261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care