Provider Demographics
NPI:1588140495
Name:WEI, HONGRU
Entity type:Individual
Prefix:
First Name:HONGRU
Middle Name:
Last Name:WEI
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 1:7766 79TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7538
Mailing Address - Country:US
Mailing Address - Phone:347-955-7316
Mailing Address - Fax:
Practice Address - Street 1:3801 23RD AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105
Practice Address - Country:US
Practice Address - Phone:917-963-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006075171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist