MEDICARE: GABRIELLA SONG PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	26NR18645700	NJ

General Provider Information

NPI Number	:	1205782745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA SONG PMHNP-BC

Provider Business Mailing Address
First Line	:	4 PIEDMONT DR
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 PIEDMONT DR
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-1712
Country	:	US
Telephone Number	:	201-240-6280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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