Provider Demographics
NPI:1144689670
Name:SONG, BALG EUN (OTR/L)
Entity type:Individual
Prefix:MR
First Name:BALG EUN
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1819
Mailing Address - Country:US
Mailing Address - Phone:215-900-4636
Mailing Address - Fax:
Practice Address - Street 1:25 VALLEY RD
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1819
Practice Address - Country:US
Practice Address - Phone:215-900-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019534-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist