| Organization Name: | SONG PHYSICAL MEDICINE, PC |
| NPI Number: | 1053358424 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANG HO SONG (OWNER) |
| Mailing Address: | 15 S Main St Edison |
| State: | NJ US |
| Postal Code: | 088373447 |
| Phone Number: | 7329916882 |
| Fax Number: | 7329060124 |
| NPI Enumeration Date: | 06/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0401X |
| License Number: | 25MB07701500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Taxonomy Definition: | |