Provider Demographics
NPI:1598599896
Name:DONG, FANGNING (LP)
Entity type:Individual
Prefix:
First Name:FANGNING
Middle Name:
Last Name:DONG
Suffix:
Gender:X
Credentials:LP
Other - Prefix:
Other - First Name:JESSY
Other - Middle Name:
Other - Last Name:DONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP
Mailing Address - Street 1:211 E 43RD ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 E 43RD ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:212-203-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health