Provider Demographics
NPI:1861459505
Name:LI, JUN (MD)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:LI
Suffix:
Gender:M
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:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-0034
Mailing Address - Country:US
Mailing Address - Phone:848-863-8700
Mailing Address - Fax:732-387-0083
Practice Address - Street 1:15 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1595
Practice Address - Country:US
Practice Address - Phone:848-863-8700
Practice Address - Fax:732-387-0083
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07743700207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064203Medicaid
NJ086481Medicare ID - Type Unspecified
NJ0064203Medicaid