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General NPI Number Information
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NPI Number | 1912307422
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Entity Type | Organization
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Legal Business Name | ALTERNATIVE MEDICAL PAIN DOCTORS
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 241 FORSGATE DR STE 107
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City | JAMESBURG
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State | NJ
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Zip | 08831-1385
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Country | US
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Telephone | 732-660-8715
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6553
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City | MONROE
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State | NJ
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Zip | 08831-6553
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Country | US
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Telephone | 732-660-8715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANG HO SONG
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Credential | D.O.
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Telephone | 732-660-8715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MB07701500
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License Number State | NJ
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