Provider Demographics
NPI:1467869255
Name:SEO, SONG WOO (DPM)
Entity Type:Individual
Prefix:DR
First Name:SONG
Middle Name:WOO
Last Name:SEO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 FRANKLIN TPKE # 202
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3516
Mailing Address - Country:US
Mailing Address - Phone:201-818-9114
Mailing Address - Fax:201-934-8223
Practice Address - Street 1:400 FRANKLIN TPKE # 202
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430
Practice Address - Country:US
Practice Address - Phone:201-818-9114
Practice Address - Fax:201-934-8223
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006600213E00000X
NJ25MD00338700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist