Provider Demographics
NPI:1669564886
Name:LI, TONG (MD)
Entity type:Individual
Prefix:
First Name:TONG
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONG
Other - Middle Name:
Other - Last Name:LI M.D., PC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:139 NORTH WOOD LANE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2161
Mailing Address - Country:US
Mailing Address - Phone:516-341-0226
Mailing Address - Fax:516-792-6787
Practice Address - Street 1:3719 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4176
Practice Address - Country:US
Practice Address - Phone:718-406-9032
Practice Address - Fax:212-888-6024
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231795207U00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03111662Medicaid