Healthcare Provider Details

I. General information

NPI: 1932780731
Provider Name (Legal Business Name): HEEYAH SONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S LENOLA RD BLDG 11-A
MOORESTOWN NJ
08057-1561
US

IV. Provider business mailing address

420 MOUNTAIN AVE FL 4
NEW PROVIDENCE NJ
07974-2736
US

V. Phone/Fax

Practice location:
  • Phone: 856-234-0222
  • Fax: 856-727-9518
Mailing address:
  • Phone: 908-458-8333
  • Fax: 908-967-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA13106900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number335964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: