Provider Demographics
NPI:1093702425
Name:SONG, SANG H SR (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:H
Last Name:SONG
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2711
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-0559
Mailing Address - Country:US
Mailing Address - Phone:631-673-1177
Mailing Address - Fax:631-489-7035
Practice Address - Street 1:740 VETERANS HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2329
Practice Address - Country:US
Practice Address - Phone:631-366-4474
Practice Address - Fax:631-366-4473
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208578208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
G95406Medicare UPIN