Provider Demographics
NPI:1538794045
Name:LU, JING RONG (NURSE PRATITIONER)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:RONG
Last Name:LU
Suffix:
Gender:F
Credentials:NURSE PRATITIONER
Other - Prefix:MISS
Other - First Name:JING
Other - Middle Name:RONG
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:757 60TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4209
Mailing Address - Country:US
Mailing Address - Phone:718-567-8899
Mailing Address - Fax:
Practice Address - Street 1:757 60TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4209
Practice Address - Country:US
Practice Address - Phone:718-567-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309513-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health