Healthcare Provider Details

I. General information

NPI: 1023413200
Provider Name (Legal Business Name): PORLENG HONG NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MARKET SQ
LYNN MA
01905-2420
US

IV. Provider business mailing address

1 GALLOWAY RD
CHELMSFORD MA
01824-1915
US

V. Phone/Fax

Practice location:
  • Phone: 781-596-3500
  • Fax:
Mailing address:
  • Phone: 978-888-3973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2264126
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: