Provider Demographics
NPI:1326589987
Name:SONG, INHYEOK (PT, DPT, LAC)
Entity type:Individual
Prefix:
First Name:INHYEOK
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:PT, DPT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 150TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4927
Mailing Address - Country:US
Mailing Address - Phone:347-827-0009
Mailing Address - Fax:
Practice Address - Street 1:3821 150TH ST FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4927
Practice Address - Country:US
Practice Address - Phone:347-827-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007322171100000X
NY039925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist