Healthcare Provider Details

I. General information

NPI: 1972970556
Provider Name (Legal Business Name): LILUN LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2015
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLUM ST FL 8
NEW BRUNSWICK NJ
08901-2066
US

IV. Provider business mailing address

135 SOMERSET ST APT 1016
NEW BRUNSWICK NJ
08901-2079
US

V. Phone/Fax

Practice location:
  • Phone: 610-513-9369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number25MA11464600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: