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General NPI Number Information
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NPI Number | 1447517727
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Entity Type | Individual
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Provider Name | MONICA SONG DMD, MPH
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Gender | Female
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 12/26/2016
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Provider Practice Location Address
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Address Line | 432 E 149TH ST
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City | BRONX
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State | NY
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Zip | 10455-1343
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Country | US
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Telephone | 718-618-7564
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Fax |
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Provider Business Mailing Address
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Address Line | 6200 HUDSON AVE 506
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-3066
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Country | US
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Telephone | 734-883-4406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 056676
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License Number State | NY
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