Provider Demographics
NPI:1982857983
Name:SONGONUGA, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SONGONUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PATRICIA CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2701
Mailing Address - Country:US
Mailing Address - Phone:201-407-3617
Mailing Address - Fax:
Practice Address - Street 1:525 PATRICIA CT
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2701
Practice Address - Country:US
Practice Address - Phone:201-407-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse