Provider Demographics
NPI:1609085810
Name:WENSONG LI MEDICINE PC
Entity Type:Organization
Organization Name:WENSONG LI MEDICINE PC
Other - Org Name:UNITED INTERVENTIONAL PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENSONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-886-7246
Mailing Address - Street 1:42-35 MAIN STREET
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3969
Mailing Address - Country:US
Mailing Address - Phone:718-886-7246
Mailing Address - Fax:718-886-7247
Practice Address - Street 1:42-35 MAIN STREET
Practice Address - Street 2:SUITE 3A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3969
Practice Address - Country:US
Practice Address - Phone:718-886-7246
Practice Address - Fax:718-886-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227245207LP2900X, 208VP0014X
NY013918208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02652624Medicaid
NY3874586Medicaid
NY02652624Medicaid
NYL23085Medicare UPIN
NY123085Medicare UPIN