Provider Demographics
NPI:1881645489
Name:SONG, ERICA YOON-JUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:YOON-JUNG
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 1:286 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2405
Mailing Address - Country:US
Mailing Address - Phone:201-569-6190
Mailing Address - Fax:201-569-6940
Practice Address - Street 1:286 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2405
Practice Address - Country:US
Practice Address - Phone:201-569-6190
Practice Address - Fax:201-569-6940
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07248000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H39505Medicare UPIN
H39505Medicare UPIN