Provider Demographics
NPI:1457499618
Name:YI, PETER I (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:I
Last Name:YI
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 1:419 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:609-430-9481
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05176900207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110137132OtherRAILROAD MED. MONROE
1811185OtherUNITED HEALTHCARE
NJ0365700Medicaid
110137127OtherRAILROAD MED. PRINCETON
MES083OtherOXFORD SPECIALTY
0429725000OtherAMERIHLTH IBC SPECIALTY
607077OtherAMERIHLTH ADMIN SPECIALTY
898197OtherAETNA HMO NONHMO SPEC.
MEP077OtherOXFORD PCP
898197OtherAETNA HMO NONHMO SPEC.
NJ607077AP0Medicare PIN