Healthcare Provider Details

I. General information

NPI: 1497568182
Provider Name (Legal Business Name): YUE RONG LMT, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BROADWAY
AMITYVILLE NY
11701-2705
US

IV. Provider business mailing address

131 KENSINGTON CT
COPIAGUE NY
11726-4311
US

V. Phone/Fax

Practice location:
  • Phone: 631-691-0200
  • Fax:
Mailing address:
  • Phone: 646-707-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007673
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: