Provider Demographics
NPI:1285704486
Name:SONG, HAODONG (MD)
Entity type:Individual
Prefix:
First Name:HAODONG
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:WICKATUNK
Mailing Address - State:NJ
Mailing Address - Zip Code:07765-0005
Mailing Address - Country:US
Mailing Address - Phone:732-707-3771
Mailing Address - Fax:732-707-3772
Practice Address - Street 1:2698 HIGHWAY 516 STE D
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2305
Practice Address - Country:US
Practice Address - Phone:732-707-3771
Practice Address - Fax:732-707-3772
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079556002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0111875OtherGHI
7927775OtherAETNA
3K3762OtherHEALTHNET
P3662677OtherOXFORD
2568130OtherUNITED HEALTHCARE
8680274OtherCIGNA
7927775OtherAETNA
100397Medicare PIN