Healthcare Provider Details

I. General information

NPI: 1235059254
Provider Name (Legal Business Name): MINKYEONG SONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 YORK AVE
NEW YORK NY
10075-0703
US

IV. Provider business mailing address

315 W 33RD ST APT 30K
NEW YORK NY
10001-2889
US

V. Phone/Fax

Practice location:
  • Phone: 212-879-8990
  • Fax:
Mailing address:
  • Phone: 857-437-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: