Provider Demographics
NPI:1760524805
Name:LI, ALICE U (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:U
Last Name:LI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-8366
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:9120 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1527
Practice Address - Country:US
Practice Address - Phone:718-641-8207
Practice Address - Fax:718-323-0414
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-07-30
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Provider Licenses
StateLicense IDTaxonomies
NY183693208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878344Medicaid
NY01015LHMedicare ID - Type Unspecified
NYH32768Medicare UPIN