Provider Demographics
NPI:1588360697
Name:ANCIENT SONG, INC.
Entity type:Organization
Organization Name:ANCIENT SONG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PORCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-778-3490
Mailing Address - Street 1:50 CHURCH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2761
Mailing Address - Country:US
Mailing Address - Phone:347-778-3490
Mailing Address - Fax:
Practice Address - Street 1:50 CHURCH ST STE 105
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2761
Practice Address - Country:US
Practice Address - Phone:347-778-3490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty