Provider Demographics
NPI:1982241790
Name:LU, QIONGQIONG
Entity type:Individual
Prefix:
First Name:QIONGQIONG
Middle Name:
Last Name:LU
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 1:967 NEWBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1620
Mailing Address - Country:US
Mailing Address - Phone:646-209-1550
Mailing Address - Fax:
Practice Address - Street 1:46 E PARK AVE FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3503
Practice Address - Country:US
Practice Address - Phone:516-208-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-30
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty