Provider Demographics
NPI:1720246465
Name:LI, WEI WEI (MD)
Entity Type:Individual
Prefix:
First Name:WEI WEI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:732-328-9363
Mailing Address - Fax:201-840-7808
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:732-328-9363
Practice Address - Fax:201-840-7808
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09015100207KA0200X
NY2488371207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6N8081OtherEMPIRE BC
NJ0315630Medicaid
NJ249509N6ZMedicare PIN
NJ222326101OtherCHN
NYA400081116Medicare PIN