Provider Demographics
NPI:1548298581
Name:LI, ANNIE HONGYAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:HONGYAN
Last Name:LI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1259 ROUTE 46
Mailing Address - Street 2:BUILDING 4C, SUITE 101
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-257-8870
Mailing Address - Fax:973-257-8871
Practice Address - Street 1:1259 ROUTE 46
Practice Address - Street 2:BUILDING 4C, SUITE 101
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4913
Practice Address - Country:US
Practice Address - Phone:973-257-8870
Practice Address - Fax:973-257-8871
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA071077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8582301Medicaid
NJ077582Medicare ID - Type Unspecified
NJ8582301Medicaid