1659805869 NPI number — LIN LI, M.D., P.A.

Table of content: (NPI 1659805869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659805869 NPI number — LIN LI, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIN LI, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659805869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 DOLORES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08817-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-246-1932
Provider Business Mailing Address Fax Number:
732-246-1936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1303 STATE ROUTE 27
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-246-1932
Provider Business Practice Location Address Fax Number:
732-246-1936
Provider Enumeration Date:
04/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LI
Authorized Official First Name:
LIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
585-315-2433

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  25MA08998100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1104100049 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0280453 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104100049 . This is a "CLOVER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104100049 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1659085869 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9540774 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1104100049 . This is a "MULTIPLAN/BEECH ST/GEHA/PHCS/CCN VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7193009 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1104100049 . This is a "AETNA BETTER HEALTH MEDICAID PLAN" identifier . This identifiers is of the category "OTHER".




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