Individual
GI SUK SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 MARYS AVE, KINGSTON, NY 12401
(845) 338-2500
(845) 338-5616
Mailing address
PO BOX 2270, KINGSTON, NY 12402-2270
(845) 339-7582
(845) 336-5616
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
170312-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01232508
—
NY
Enumeration date
07/11/2006
Last updated
05/22/2018
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