Provider Demographics
NPI:1437217171
Name:XU, SIRONG (ACUPUNCTURIST)
Entity type:Individual
Prefix:MRS
First Name:SIRONG
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 EAST CEDAR STREET
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-716-9083
Mailing Address - Fax:973-716-9628
Practice Address - Street 1:29 N LIVINGSTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:973-597-1887
Practice Address - Fax:973-716-9628
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMZ000068171100000X
NY0003061171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist