Provider Demographics
NPI:1801140942
Name:SONG, WEI (LAC)
Entity type:Individual
Prefix:MR
First Name:WEI
Middle Name:
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 1:1592 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4737
Mailing Address - Country:US
Mailing Address - Phone:914-374-9917
Mailing Address - Fax:
Practice Address - Street 1:40 TRIANGLE CTR
Practice Address - Street 2:SUITE 217
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4188
Practice Address - Country:US
Practice Address - Phone:914-352-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist