Basic Information
Provider Information
NPI: 1306835327
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TSONG
FirstName: SHIRLEY
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22581
Address2:  
City: NEW YORK
State: NY
PostalCode: 100872581
CountryCode: US
TelephoneNumber: 8566696050
FaxNumber: 7328427352
Practice Location
Address1: 180 WHITE RD
Address2: SUITE 209
City: LITTLE SILVER
State: NJ
PostalCode: 077391166
CountryCode: US
TelephoneNumber: 7328420673
FaxNumber: 7328427352
Other Information
ProviderEnumerationDate: 10/21/2005
LastUpdateDate: 07/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X25MA06946800NJY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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