Provider Demographics
NPI:1811268451
Name:DR LISA LI LLC
Entity type:Organization
Organization Name:DR LISA LI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-873-5712
Mailing Address - Street 1:225 ROUTE 10 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1300
Mailing Address - Country:US
Mailing Address - Phone:201-873-5712
Mailing Address - Fax:
Practice Address - Street 1:225 ROUTE 10 E
Practice Address - Street 2:SUITE 101
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1300
Practice Address - Country:US
Practice Address - Phone:973-584-1405
Practice Address - Fax:973-584-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07630500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI02024Medicare UPIN
NJ237242Medicare PIN