Provider Demographics
NPI:1760574289
Name:LI, RONALD W (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:LI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2650 CONSTITUTION CENTER
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512
Mailing Address - Country:US
Mailing Address - Phone:609-655-3000
Mailing Address - Fax:609-655-3003
Practice Address - Street 1:2650 CONSTITUTION CENTER
Practice Address - Street 2:SUITE B
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512
Practice Address - Country:US
Practice Address - Phone:609-655-3000
Practice Address - Fax:609-655-3003
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05296300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62452278OtherMULTIPLAN
5710527OtherGHI
5710527OtherGHI
550134A47Medicare PIN