MEDICARE: DR. FANGQIN LI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	240642	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240642	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1427198076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FANGQIN LI MD

Provider Business Mailing Address
First Line	:	2500 NESCONSET HWY
Second Line	:	BLDG 12C
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2553
Country	:	US
Telephone Number	:	631-751-5550
Fax Number	:	631-689-5472

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY BLDG 12C
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2553
Country	:	US
Telephone Number	:	631-751-5550
Fax Number	:	631-689-5472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	04/16/2025

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