Provider Demographics
NPI:1780994020
Name:SONG, YING
Entity type:Individual
Prefix:MS
First Name:YING
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:YING
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6748 SPRINGFIELD BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2630
Mailing Address - Country:US
Mailing Address - Phone:718-225-2833
Mailing Address - Fax:718-225-2833
Practice Address - Street 1:6748 SPRINGFIELD BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2630
Practice Address - Country:US
Practice Address - Phone:718-225-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist