Provider Demographics
NPI:1467660712
Name:JOAN LI, MD PC
Entity Type:Organization
Organization Name:JOAN LI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-445-9088
Mailing Address - Street 1:13527 38TH AVE STE 398
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4448
Mailing Address - Country:US
Mailing Address - Phone:718-445-9088
Mailing Address - Fax:718-445-5348
Practice Address - Street 1:13527 38TH AVE STE 398
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4448
Practice Address - Country:US
Practice Address - Phone:718-445-9088
Practice Address - Fax:718-445-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211916261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02204337Medicaid
NY02204337Medicaid