Provider Demographics
NPI:1710386990
Name:WU, CHUNRONG (LAC)
Entity Type:Individual
Prefix:
First Name:CHUNRONG
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 OAK ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2553
Mailing Address - Country:US
Mailing Address - Phone:732-766-3092
Mailing Address - Fax:
Practice Address - Street 1:566 7TH AVE RM 601A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1946
Practice Address - Country:US
Practice Address - Phone:212-575-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001577171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist