Provider Demographics
NPI:1922177419
Name:LI COMPLEMENTARY & FAMILY MEDICAL CARE, P.C.
Entity Type:Organization
Organization Name:LI COMPLEMENTARY & FAMILY MEDICAL CARE, P.C.
Other - Org Name:JAMES Y.Z. WU, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:YZ
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-8258
Mailing Address - Street 1:112 ALEXANDER AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-0429
Mailing Address - Country:US
Mailing Address - Phone:631-265-8258
Mailing Address - Fax:631-265-8256
Practice Address - Street 1:112 ALEXANDER AVE UNIT B
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-0429
Practice Address - Country:US
Practice Address - Phone:631-265-8258
Practice Address - Fax:631-265-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI04654Medicare UPIN
NYWGW521Medicare ID - Type Unspecified