Provider Demographics
NPI:1437506201
Name:JONG, HEANGHO
Entity Type:Individual
Prefix:
First Name:HEANGHO
Middle Name:
Last Name:JONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HUDSON
Other - Middle Name:
Other - Last Name:JONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:417 MORRIS AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1503
Mailing Address - Country:US
Mailing Address - Phone:201-595-0404
Mailing Address - Fax:
Practice Address - Street 1:20 NORDHOFF PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4811
Practice Address - Country:US
Practice Address - Phone:201-567-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ001142000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist