Provider Demographics
NPI:1154727626
Name:HONG, IRENE (LAC LMT)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FLANAGAN WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3445
Mailing Address - Country:US
Mailing Address - Phone:201-381-1127
Mailing Address - Fax:
Practice Address - Street 1:150 FLANAGAN WAY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3445
Practice Address - Country:US
Practice Address - Phone:201-381-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005423171100000X
NJ18KT00165200225700000X
NJ25MZ00112600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist