Provider Demographics
NPI:1902216328
Name:SONG, SHUHUA (MB)
Entity Type:Individual
Prefix:DR
First Name:SHUHUA
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:MB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604675
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-4675
Mailing Address - Country:US
Mailing Address - Phone:718-878-6920
Mailing Address - Fax:718-878-6920
Practice Address - Street 1:4161 KISSENA BLVD STE C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3105
Practice Address - Country:US
Practice Address - Phone:718-878-6920
Practice Address - Fax:718-878-6920
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289940208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist