Provider Demographics
NPI:1295445260
Name:LI, WENYU (LMT)
Entity type:Individual
Prefix:MR
First Name:WENYU
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 170TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1948
Mailing Address - Country:US
Mailing Address - Phone:347-399-4031
Mailing Address - Fax:
Practice Address - Street 1:115 BROADHOLLOW RD STE MELVILLE
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4992
Practice Address - Country:US
Practice Address - Phone:631-990-4352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033142225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist