Provider Demographics
NPI:1447549134
Name:LI DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:LI DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-389-3888
Mailing Address - Street 1:4160 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3833
Mailing Address - Country:US
Mailing Address - Phone:347-389-3888
Mailing Address - Fax:718-889-2411
Practice Address - Street 1:4160 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3833
Practice Address - Country:US
Practice Address - Phone:347-389-3888
Practice Address - Fax:718-889-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-03
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244852207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty