MEDICARE: JIANJUN LI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	203883	NY
2	174400000X	Specialist	25MA09606000	NJ

General Provider Information

NPI Number	:	1437171683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIANJUN LI M.D.

Provider Business Mailing Address
First Line	:	730 58TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3917
Country	:	US
Telephone Number	:	718-567-8808
Fax Number	:	718-567-8820

Provider Business Practice Location Address
First Line	:	730 58TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3917
Country	:	US
Telephone Number	:	718-567-8808
Fax Number	:	718-567-8820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	04/02/2015

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