MEDICARE: CASTLE OF HEALTH MEDICAL OFFICE, P.C.

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	261QP2300X	Primary Care Clinic/Center	232861	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982800439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASTLE OF HEALTH MEDICAL OFFICE, P.C.

Provider Business Mailing Address
First Line	:	45 N CLOVER DR
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1013
Country	:	US
Telephone Number	:	718-358-6768
Fax Number	:	718-358-6783

Provider Business Practice Location Address
First Line	:	3916 PRINCE ST STE 351
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-5361
Country	:	US
Telephone Number	:	718-358-6768
Fax Number	:	718-358-6783

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YUAN YI LI
Credential	:	M.D.
Telephone Number	:	718-358-6768

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	01/17/2016

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Directions to “CASTLE OF HEALTH MEDICAL OFFICE, P.C. ” Practice Location

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