=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376672410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIWEI TONG, M.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 09/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 666 PLAINSBORO RD STE 1005 BLDG. 1000
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-275-6810
-----------------------------------------------------
Fax | 609-275-8862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 666 PLAINSBORO RD STE 1005 BLDG. 1000
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-275-6810
-----------------------------------------------------
Fax | 609-275-8862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND OWNER
-----------------------------------------------------
Name | SHIWEI TONG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 609-275-6810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MA074825
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------