Provider Demographics
NPI:1437171683
Name:LI, JIANJUN (MD)
Entity Type:Individual
Prefix:
First Name:JIANJUN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3917
Mailing Address - Country:US
Mailing Address - Phone:718-567-8808
Mailing Address - Fax:718-567-8820
Practice Address - Street 1:730 58TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3917
Practice Address - Country:US
Practice Address - Phone:718-567-8808
Practice Address - Fax:718-567-8820
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203883207RG0100X
NJ25MA09606000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY256ANEM171Medicare PIN
NY256AN1Medicare PIN