Healthcare Provider Details

I. General information

NPI: 1508793092
Provider Name (Legal Business Name): EUGENE SONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1898
US

IV. Provider business mailing address

33 HENRY PL APT B5
HACKENSACK NJ
07601-6600
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3000
  • Fax:
Mailing address:
  • Phone: 201-927-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ15626400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18118200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number723063
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197984
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: