Individual
BRENTON JAY SEUNG HOON SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4740 PEACH ST, ERIE, PA 16509-2008
(814) 454-3174
(814) 616-8002
Mailing address
1 LECOM PL, ERIE, PA 16505-2571
(814) 868-2529
(814) 868-2522
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
OS021405
PA
Other
Enumeration date
06/14/2018
Last updated
05/31/2023
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