Healthcare Provider Details

I. General information

NPI: 1891280624
Provider Name (Legal Business Name): CHI MAN LEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1104
US

IV. Provider business mailing address

75-25 153RD ST, FLUSHING APT PH14
NEW YORK CITY NY
11367-3090
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4080
  • Fax:
Mailing address:
  • Phone: 215-253-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036155546
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0028364
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: