Provider Demographics
NPI:1659805869
Name:LIN LI, M.D., P.A.
Entity Type:Organization
Organization Name:LIN LI, M.D., P.A.
Other - Org Name:FAMILY ALLERGY AND ASTHMA CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-315-2433
Mailing Address - Street 1:15 DOLORES DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2328
Mailing Address - Country:US
Mailing Address - Phone:732-246-1932
Mailing Address - Fax:732-246-1936
Practice Address - Street 1:1303 STATE ROUTE 27
Practice Address - Street 2:SUITE 5
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3456
Practice Address - Country:US
Practice Address - Phone:732-246-1932
Practice Address - Fax:732-246-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08998100261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104100049OtherTRICARE
NJ0280453Medicaid
1104100049OtherCLOVER HEALTH
1104100049OtherAMERIGROUP
NJ1659085869OtherAMERIHEALTH
NJ9540774OtherAETNA
1104100049OtherMULTIPLAN/BEECH ST/GEHA/PHCS/CCN VA
NJ7193009OtherCIGNA
1104100049OtherAETNA BETTER HEALTH MEDICAID PLAN
NJ0280453Medicaid
1104100049OtherAETNA BETTER HEALTH MEDICAID PLAN
1104100049OtherAMERIGROUP
1104100049OtherMULTIPLAN/BEECH ST/GEHA/PHCS/CCN VA
NJ=========OtherMAGNACARE
NJ=========OtherINTERGROUP