Provider Demographics
NPI:1740235795
Name:LI, LYNN XIAOLIN (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:XIAOLIN
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 1:15 SCHOOL RD E
Mailing Address - Street 2:#2
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2062
Mailing Address - Country:US
Mailing Address - Phone:732-462-0111
Mailing Address - Fax:732-462-7711
Practice Address - Street 1:15 SCHOOL RD E
Practice Address - Street 2:#2
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2062
Practice Address - Country:US
Practice Address - Phone:732-462-0111
Practice Address - Fax:732-462-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07171600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8576904Medicaid
NJ050616Medicare ID - Type Unspecified
H07039Medicare UPIN