Provider Demographics
NPI:1942377684
Name:ZENG, RODGER (LIC AC)
Entity Type:Individual
Prefix:
First Name:RODGER
Middle Name:
Last Name:ZENG
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 HARTFORD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7145
Mailing Address - Country:US
Mailing Address - Phone:401-861-7555
Mailing Address - Fax:
Practice Address - Street 1:1343 HARTFORD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7145
Practice Address - Country:US
Practice Address - Phone:401-861-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00103171100000X
MA585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist