Healthcare Provider Details

I. General information

NPI: 1174739007
Provider Name (Legal Business Name): SONG Y CHUNG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3628
US

IV. Provider business mailing address

337 BROOKSIDE AVE
WYCKOFF NJ
07481-3469
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-5799
  • Fax: 201-634-5776
Mailing address:
  • Phone: 201-824-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01971100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: