Provider Demographics
NPI:1891115671
Name:SONG HEART AND VASCULAR PC
Entity Type:Organization
Organization Name:SONG HEART AND VASCULAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-207-2650
Mailing Address - Street 1:153 CHARLOTTE PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1616
Mailing Address - Country:US
Mailing Address - Phone:917-207-2650
Mailing Address - Fax:
Practice Address - Street 1:13656 39TH AVE
Practice Address - Street 2:2ND FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5598
Practice Address - Country:US
Practice Address - Phone:718-886-7575
Practice Address - Fax:718-886-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240614207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty