Healthcare Provider Details

I. General information

NPI: 1174819916
Provider Name (Legal Business Name): HONGJIE LI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SEASIDE AVE
MILFORD CT
06460-4600
US

IV. Provider business mailing address

PO BOX 417297
BOSTON MA
02241-7297
US

V. Phone/Fax

Practice location:
  • Phone: 203-876-4000
  • Fax: 215-957-2875
Mailing address:
  • Phone: 866-623-3869
  • Fax: 866-465-4714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number279279
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number054703
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: