Provider Demographics
NPI:1205412749
Name:SONG, NIKI JINLU (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKI
Middle Name:JINLU
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E 81ST ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1893
Mailing Address - Country:US
Mailing Address - Phone:860-861-5621
Mailing Address - Fax:
Practice Address - Street 1:10 NATHAN D PERLMAN PL FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3841
Practice Address - Country:US
Practice Address - Phone:212-420-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program