Provider Demographics
NPI:1669561999
Name:SONG, JASON J (MD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:J
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:300 COMMUNITY DR
Mailing Address - Street 2:DEPARTMENT OF CARDIOLOGY
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3816
Mailing Address - Country:US
Mailing Address - Phone:516-562-4100
Mailing Address - Fax:516-562-3992
Practice Address - Street 1:300 COMMUNITY DR
Practice Address - Street 2:DEPARTMENT OF CARDIOLOGY
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3816
Practice Address - Country:US
Practice Address - Phone:516-562-4100
Practice Address - Fax:516-562-3992
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY240614207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400031001Medicare PIN