Provider Demographics
NPI:1821712829
Name:RONG, MICHELLE MIN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MIN
Last Name:RONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E MIDDLE COUNTRY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2822
Mailing Address - Country:US
Mailing Address - Phone:631-780-5511
Mailing Address - Fax:631-780-5512
Practice Address - Street 1:323 E MIDDLE COUNTRY RD STE 3
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2822
Practice Address - Country:US
Practice Address - Phone:631-780-5511
Practice Address - Fax:631-780-5512
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000919171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY698653218Other171100000X