Provider Demographics
NPI:1962460386
Name:LI, LEONID (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONID
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 1:8 DARIA LN
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1268
Mailing Address - Country:US
Mailing Address - Phone:973-625-6681
Mailing Address - Fax:973-983-2367
Practice Address - Street 1:1 DIAMOND HILL RD FL G
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8699
Practice Address - Fax:908-673-7388
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06749600207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0037923Medicaid
NJH04771Medicare UPIN
NJ0037923Medicaid