Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MA69999 | NJ |
N | 111NI0900X | Internist | MA69999 | NJ |
Y | 207RG0300X | Geriatric Medicine | MA69999 | NJ |
NPI | 1134278526 |
---|---|
Provider Name | Dr. Yong Shi |
First Address | Marlboro, NJ 07746-2709 |
Second Address | Marlboro, NJ 07746-2709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 16/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H32737 | (02) | NJ |