MEDICARE: CARING HOSPITALIST LI 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1649897398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARING HOSPITALIST LI MEDICAL PC

Provider Business Mailing Address
First Line	:	90 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-796-4433
Fax Number	:	516-796-4288

Provider Business Practice Location Address
First Line	:	90 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-796-4433
Fax Number	:	516-796-4288

Authorized Official
Title or Position	:	MD
Name	:	BITA ASHOURZADEH
Credential	:
Telephone Number	:	516-610-5081

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	05/25/2021

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