Provider Demographics
NPI:1801298328
Name:SONG, MYUNGSEOK
Entity type:Individual
Prefix:
First Name:MYUNGSEOK
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 BANTA PL APT A
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-3710
Mailing Address - Country:US
Mailing Address - Phone:201-554-5559
Mailing Address - Fax:
Practice Address - Street 1:30 KINDERKAMACK RD STE 2
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2664
Practice Address - Country:US
Practice Address - Phone:201-554-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist