Provider Demographics
NPI:1275958308
Name:YONG SHI, MD LLC
Entity Type:Organization
Organization Name:YONG SHI, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-775-6664
Mailing Address - Street 1:1820 CORLIES AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4860
Mailing Address - Country:US
Mailing Address - Phone:732-775-6664
Mailing Address - Fax:732-775-6680
Practice Address - Street 1:1820 CORLIES AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4860
Practice Address - Country:US
Practice Address - Phone:732-775-6664
Practice Address - Fax:732-775-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06999900207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0066117Medicaid
NJ049408Medicare PIN
NJ0066117Medicaid