Provider Demographics
NPI:1104100049
Name:LI, LIN (MD)
Entity type:Individual
Prefix:DR
First Name:LIN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DOLORES DR
Mailing Address - Street 2:NJ 08817
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:585-315-2433
Mailing Address - Fax:
Practice Address - Street 1:15 DOLORES DR
Practice Address - Street 2:NJ 08817
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:585-315-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08998100207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ230120OtherCHN
NJ7N0981OtherEMPIRE BC
NJ0280453Medicaid
NJ1104100049OtherCOVENTRY HEALTH-FIRST HEALTH
NJ1104100049OtherHORIZON BCBS
NJ3869679000OtherAMERIHEALTH
NJ60177190OtherHORIZON N.J. FAMILYCARE
NJ7193009OtherCIGNA
NJ1097116OtherWELLCARE
NJ1104100049OtherUNITED HEATHLCARE
NJ9540774OtherAETNA PPO
NJP5255704OtherOXFORD
NJ1097116OtherU.S.FAMILY
NJ1104100049OtherAMERIGROUP
NJ5227444OtherAETNA HMO
NJ1104100049OtherVISTA HEALTHCARE SYSTEM & OPTIMUS
NJ5227444OtherAETNA HMO