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General NPI Number Information
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NPI Number | 1922177419
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Entity Type | Organization
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Legal Business Name | LI COMPLEMENTARY & FAMILY MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 112 ALEXANDER AVE UNIT B
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City | LAKE GROVE
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State | NY
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Zip | 11755-0429
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Country | US
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Telephone | 631-265-8258
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Fax | 631-265-8256
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Provider Business Mailing Address
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Address Line | 112 ALEXANDER AVE UNIT B
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City | LAKE GROVE
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State | NY
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Zip | 11755-0429
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Country | US
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Telephone | 631-265-8258
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Fax | 631-265-8256
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAMES Y.Z. WU
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Credential | M.D.
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Telephone | 631-265-8258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 229361
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License Number State | NY
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