Provider Demographics
NPI:1952386518
Name:SONG, SANG HO (DO)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:HO
Last Name:SONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 FORSGATE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1385
Mailing Address - Country:US
Mailing Address - Phone:732-660-8715
Mailing Address - Fax:732-906-0124
Practice Address - Street 1:241 FORSGATE DR
Practice Address - Street 2:107
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1385
Practice Address - Country:US
Practice Address - Phone:732-660-8715
Practice Address - Fax:732-906-0124
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07701500208100000X
NY231625208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08485500OtherCDS
NJD08485500OtherCDS
NJD08485500OtherCDS