Provider Demographics
NPI:1750335667
Name:LI, RONGSHAN (MD)
Entity type:Individual
Prefix:DR
First Name:RONGSHAN
Middle Name:
Last Name:LI
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 1:535 E CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2922
Mailing Address - Country:US
Mailing Address - Phone:201-661-7280
Mailing Address - Fax:201-661-7297
Practice Address - Street 1:100 KESTREL DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2060
Practice Address - Country:US
Practice Address - Phone:610-831-5354
Practice Address - Fax:610-831-5358
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47440207ZP0102X
NJ25MA08650800207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000030377SOtherHUMANA
WI34584000Medicaid
NJ171967ZA0ZMedicare PIN
000030377SOtherHUMANA