1891115671 NPI number — SONG HEART AND VASCULAR PC

Table of content: (NPI 1891115671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891115671 NPI number — SONG HEART AND VASCULAR PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONG HEART AND VASCULAR PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891115671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 CHARLOTTE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD CLIFFS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07632-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-207-2650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13656 39TH AVE
Provider Second Line Business Practice Location Address:
2ND FL
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-5598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-886-7575
Provider Business Practice Location Address Fax Number:
718-886-7574
Provider Enumeration Date:
04/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SONG
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
917-207-2650

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  240614 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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