MEDICARE: JIANJUN LI GI MEDICAL PC

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	174400000X	Specialist	244434	NY
2	174400000X	Specialist	257725	NY
3	174400000X	Specialist	25MA08744000	NJ
4	174400000X	Specialist	25MA09606000	NJ
5	174400000X	Specialist	25MA09610400	NJ
6	174400000X	Specialist	203883	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538340203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIANJUN LI GI MEDICAL PC

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	:	OFFICE MANAGER
Name	:	WINNIE CHAN
Credential	:
Telephone Number	:	718-567-8808

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	03/31/2015

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Directions to “JIANJUN LI GI MEDICAL PC ” Practice Location

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