Active NPI
In Pom Song
- Pharmacist
- Astoria, NY
National Provider Identifier
1437283512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 046758-1
- Practice address
- 4116 30TH Ave
Astoria, NY 11103-2998 - Phone
- (718) 204-1414
- Fax
- (718) 204-1413
- NPI assigned
- Mar 14, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 046758-1 | NY | Primary |
Addresses
Primary practice location
4116 30TH Ave
Astoria, NY 11103-2998
Mailing address
4116 30TH Ave
Astoria, NY 11103-2998
Phone (718) 204-1414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046758-1 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| M & I Management, Inc. | Pharmacist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437283512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4116 30TH AVE",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111032998",
"telephone_number": "718-204-1414",
"fax_number": "718-204-1413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4116 30TH AVE",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111032998",
"telephone_number": "718-204-1414",
"fax_number": "718-204-1413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "IN",
"middle_name": "POM",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "046758-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Astoria, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.