Provider Demographics
NPI:1275646010
Name:CHOI, SONG JA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SONG JA
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 PARSONS BLVD
Mailing Address - Street 2:1D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5832
Mailing Address - Country:US
Mailing Address - Phone:718-762-1710
Mailing Address - Fax:718-762-1753
Practice Address - Street 1:3834 PARSONS BLVD
Practice Address - Street 2:1D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5832
Practice Address - Country:US
Practice Address - Phone:718-762-1710
Practice Address - Fax:718-762-1753
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP-331300-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine