Provider Demographics
NPI:1083942874
Name:SONG, UNE HO (LAC DIPLOM)
Entity Type:Individual
Prefix:
First Name:UNE
Middle Name:HO
Last Name:SONG
Suffix:
Gender:M
Credentials:LAC DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:282 GRAND AVE
Mailing Address - Street 2:STE. 2
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4370
Mailing Address - Country:US
Mailing Address - Phone:201-871-8702
Mailing Address - Fax:210-871-8706
Practice Address - Street 1:133 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1634
Practice Address - Country:US
Practice Address - Phone:201-870-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00071400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist