Provider Demographics
NPI:1609980044
Name:LI, MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 51ST ST
Mailing Address - Street 2:OFFICE A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-8014
Mailing Address - Country:US
Mailing Address - Phone:212-688-8887
Mailing Address - Fax:212-688-1243
Practice Address - Street 1:420 E 51ST ST
Practice Address - Street 2:OFFICE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-8014
Practice Address - Country:US
Practice Address - Phone:212-688-8887
Practice Address - Fax:212-688-1243
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197405207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY197405A20OtherHEALTHFIRST
NY52772OtherGHI HMO
NY10774POtherHIP
NYP401354OtherOXFORD
NY133887329OtherTAX IDENITIFICATION
NY2C3376OtherHEALTHNET
NY153371Medicare ID - Type Unspecified
NY52772OtherGHI HMO