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Organization
LI MEDICAL GROUP PLLC
Active
Organization
LI MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUKE WALTON (ENROLLMENT MANAGER)
(951) 900-3156
Entity
Organization
Contact information
Practice address
2090 JERICHO TPKE, NEW HYDE PARK, NY 11040-4719
(516) 352-7828
Mailing address
2090 JERICHO TPKE, NEW HYDE PARK, NY 11040-4719
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01439550
—
NY
Enumeration date
08/29/2019
Last updated
06/10/2020
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