Provider Demographics
NPI:1538498639
Name:LI, LIYE (MD)
Entity type:Individual
Prefix:DR
First Name:LIYE
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 8TH AVE UNIT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3515
Mailing Address - Country:US
Mailing Address - Phone:718-437-3855
Mailing Address - Fax:718-437-3856
Practice Address - Street 1:5521 8TH AVE UNIT 3C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3515
Practice Address - Country:US
Practice Address - Phone:718-437-3855
Practice Address - Fax:718-437-3856
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247552208D00000X, 207U00000X, 208U00000X, 207R00000X
NJ29MA08925900207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03845732Medicaid
NYG300068417Medicare PIN