Provider Demographics
NPI:1053358424
Name:SONG PHYSICAL MEDICINE, PC
Entity type:Organization
Organization Name:SONG PHYSICAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG HO
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-991-6882
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08818-1241
Mailing Address - Country:US
Mailing Address - Phone:732-991-6882
Mailing Address - Fax:732-906-0124
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3447
Practice Address - Country:US
Practice Address - Phone:732-991-6882
Practice Address - Fax:732-906-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07701500261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4824194OtherCIGNA
NJ9353766OtherPRIVATE HEALTHCARE SYSTEM
NJ2286772OtherFIRST HEALTH
NJ3587468OtherAETNA
NJ2465083OtherUNITED HEALTHCARE
NJ5050G1OtherEMPIRE BC/BS
NJP3308943OtherOXFORD
NJP3308943OtherOXFORD
NJ079592BPVMedicare ID - Type Unspecified