Provider Demographics
NPI:1174819916
Name:LI, HONGJIE (DO)
Entity type:Individual
Prefix:DR
First Name:HONGJIE
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417297
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7297
Mailing Address - Country:US
Mailing Address - Phone:866-623-3869
Mailing Address - Fax:866-465-4714
Practice Address - Street 1:300 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4600
Practice Address - Country:US
Practice Address - Phone:203-876-4000
Practice Address - Fax:215-957-2875
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279279207L00000X
CT054703207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology