Provider Demographics
NPI:1710974357
Name:LI, JIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 SUNSHINE COTTAGE ROAD
Mailing Address - Street 2:NEW YORK MEDICAL COLLEGE, NEUROLOGY DEPARTMENT
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-594-2200
Mailing Address - Fax:914-594-2201
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:STE. 2850
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-345-1313
Practice Address - Fax:914-345-5004
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223775-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02243603Medicaid
NY130025241OtherRAILROAD MEDICARE
NYW7Z231Medicare PIN
424N61Medicare ID - Type Unspecified
H61184Medicare UPIN