Provider Demographics
NPI:1013271741
Name:LI, CONRAD (MD)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13620 MAPLE AVE # C702
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5166
Mailing Address - Country:US
Mailing Address - Phone:347-368-4288
Mailing Address - Fax:347-368-4785
Practice Address - Street 1:13620 MAPLE AVE # C702
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5166
Practice Address - Country:US
Practice Address - Phone:347-368-4288
Practice Address - Fax:347-368-4785
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY280627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine