Provider Demographics
NPI:1134278526
Name:SHI, YONG (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:
Last Name:SHI
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 1:10 WITHERSPOON WAY
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2709
Mailing Address - Country:US
Mailing Address - Phone:732-245-6461
Mailing Address - Fax:732-303-0997
Practice Address - Street 1:10 WITHERSPOON WAY
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2709
Practice Address - Country:US
Practice Address - Phone:732-245-6461
Practice Address - Fax:732-303-0997
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69999207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ049408Medicare ID - Type Unspecified
NJH32737Medicare UPIN