Provider Demographics
NPI:1467483917
Name:SONG, MIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:
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 1:227 MADISON ST
Mailing Address - Street 2:MEDICINE, 4TH FLOOR, GOUVERNEUR HEALTHCARE SERVICES
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7537
Mailing Address - Country:US
Mailing Address - Phone:212-238-7444
Mailing Address - Fax:212-238-7668
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:MEDICINE, 4TH FLOOR, GOUVERNEUR HEALTHCARE SERVICES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7444
Practice Address - Fax:212-238-7668
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1991455Medicaid
NY854461Medicare PIN