Provider Demographics
NPI:1457684003
Name:SONG, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SONG
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 1:724 HARMON COVE TOWER
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-1749
Mailing Address - Country:US
Mailing Address - Phone:201-723-8667
Mailing Address - Fax:
Practice Address - Street 1:724 HARMON COVE TOWER
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-1749
Practice Address - Country:US
Practice Address - Phone:201-723-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004020-1171100000X
NJ25MZ00067400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist