Healthcare Provider Details

I. General information

NPI: 1609085810
Provider Name (Legal Business Name): WENSONG LI MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42-35 MAIN STREET SUITE 3A
FLUSHING NY
11355-3969
US

IV. Provider business mailing address

42-35 MAIN STREET SUITE 3A
FLUSHING NY
11355-3969
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-7246
  • Fax: 718-886-7247
Mailing address:
  • Phone: 718-886-7246
  • Fax: 718-886-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number227245
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number013918
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number227245
License Number StateNY

VIII. Authorized Official

Name: DR. WENSONG LI
Title or Position: PRESIDENT
Credential: MD
Phone: 718-886-7246