Provider Demographics
NPI:1124141478
Name:LI, YONGMING (MD, PHD, AC)
Entity type:Individual
Prefix:DR
First Name:YONGMING
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:MD, PHD, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1874
Mailing Address - Country:US
Mailing Address - Phone:908-203-0471
Mailing Address - Fax:
Practice Address - Street 1:GREEN KNOLL PROFESSIONAL PARK
Practice Address - Street 2:720 ROUTE 202-206 NORTH STE 1C
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-203-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07422800207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH73478Medicare UPIN