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General NPI Number Information
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NPI Number | 1710642301
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Entity Type | Individual
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Provider Name | JENNY WON SONG FNP
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Gender | Female
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 555 MADISON AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10022-3337
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Country | US
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Telephone | 646-754-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4545 CENTER BLVD APT 1716
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City | LONG ISLAND CITY
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State | NY
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Zip | 11109-5934
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 348140
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License Number State | NY
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