Provider Demographics
NPI:1376427856
Name:GONG, FENRONG (PHYSICAL THERAPY)
Entity type:Individual
Prefix:MRS
First Name:FENRONG
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 UNION ST FL 4
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2452
Mailing Address - Country:US
Mailing Address - Phone:917-294-4321
Mailing Address - Fax:
Practice Address - Street 1:4123 UNION ST FL 4
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2452
Practice Address - Country:US
Practice Address - Phone:917-294-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist