MEDICARE: DR. XIAO LI REN 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	207R00000X	Internal Medicine Physician	207200	NY
2	207RC0000X	Cardiovascular Disease Physician	207200	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	:	1699731471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XIAO LI REN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 95000-6580
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-6580
Country	:	US
Telephone Number	:	631-465-6297
Fax Number	:	631-465-6524

Provider Business Practice Location Address
First Line	:	100 PORT WASHINGTON BLVD
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1347
Country	:	US
Telephone Number	:	516-277-4959
Fax Number	:	516-622-4551

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	10/17/2014

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