Provider Demographics
NPI:1992704993
Name:HOUNG, MINDY S (MD)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:S
Last Name:HOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19 FENTON DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3127
Mailing Address - Country:US
Mailing Address - Phone:973-467-6737
Mailing Address - Fax:
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-322-6256
Practice Address - Fax:973-322-6241
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07662600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI19876Medicare UPIN
NJ084702RRAMedicare ID - Type Unspecified