Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | P9261 | TX |
N | 208600000X | Surgeon | P9261 | TX |
N | 2086S0102X | Surgical Critical Care | 03713 | KY |
Y | 2086S0102X | Surgical Critical Care | 280069 | NY |
NPI | 1043445075 |
---|---|
Provider Name | Cherry Song |
First Address | Middletown, NY 10940-2650 |
Second Address | Middletown, NY 10940-2650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 19/04/2017 |