Healthcare Provider Details

I. General information

NPI: 1083526305
Provider Name (Legal Business Name): SHIH JHE LI RN,RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 907
HACKENSACK NJ
07601-1989
US

IV. Provider business mailing address

230 ANDERSON ST APT 7J
HACKENSACK NJ
07601-3538
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-2550
  • Fax:
Mailing address:
  • Phone: 551-293-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR25021800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: