Provider Demographics
NPI:1396560520
Name:SONG, MICHAEL M (LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:SONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3204
Mailing Address - Country:US
Mailing Address - Phone:914-539-0366
Mailing Address - Fax:
Practice Address - Street 1:10 CRESCENT LN
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3204
Practice Address - Country:US
Practice Address - Phone:914-439-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist