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General NPI Number Information
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NPI Number | 1649576760
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Entity Type | Organization
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Legal Business Name | SHU PING RONG, DDS P.C
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 128 MOTT ST SUITE # 507
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City | NEW YORK
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State | NY
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Zip | 10013-5540
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Country | US
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Telephone | 212-226-6368
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Fax | 212-226-6369
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Provider Business Mailing Address
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Address Line | 128 MOTT ST SUITE # 507
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City | NEW YORK
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State | NY
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Zip | 10013-5540
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Country | US
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Telephone | 212-226-6368
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Fax | 212-226-6369
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHU PING RONG
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Credential | DDS
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Telephone | 917-816-2085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 055002
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License Number State | NY
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