Healthcare Provider Details

I. General information

NPI: 1407485022
Provider Name (Legal Business Name): CHARLES LI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMERSET ST
NEW BRUNSWICK NJ
08901-1942
US

IV. Provider business mailing address

5555 GLENRIDGE CONNECTOR STE 700
SANDY SPRINGS GA
30342-4758
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number347006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: