Provider Demographics
NPI:1295070902
Name:GONG, QINHUA (LAC)
Entity type:Individual
Prefix:
First Name:QINHUA
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:999 ROUTE 73 N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1227
Mailing Address - Country:US
Mailing Address - Phone:856-802-6888
Mailing Address - Fax:856-802-6878
Practice Address - Street 1:999 ROUTE 73 N
Practice Address - Street 2:SUITE 200
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1227
Practice Address - Country:US
Practice Address - Phone:856-802-6888
Practice Address - Fax:856-802-6878
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00060300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist