Healthcare Provider Details

I. General information

NPI: 1982967949
Provider Name (Legal Business Name): ANDREW RONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136
US

IV. Provider business mailing address

1900 NW 17TH ST
MIAMI FL
33125-1404
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-2020
  • Fax:
Mailing address:
  • Phone: 305-243-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME135518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: