1295721777 NPI number — DR. JINSUP SONG DPM PHD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295721777 NPI number — DR. JINSUP SONG DPM PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SONG
Provider First Name:
JINSUP
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295721777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TEMPLE UNIVERSITY FOOT AND ANKLE INSTITUTE PO BOX 22433
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-2433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-777-5808
Provider Business Mailing Address Fax Number:
215-777-5716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 N 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-2496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-777-5808
Provider Business Practice Location Address Fax Number:
215-777-5825
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC004393L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213EP1101X , with the licence number: SC004393L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018076090003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8259607 . This is a "NJ MEDICAL ASSISTANCE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 893038 . This is a "KEYSTONE HEALTH PLAN PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1125735 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231365971 . This is a "HUMANA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1807609 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2665731 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0499950000 . This is a "KEYSTONE HEALTH PLAN HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231365971071 . This is a "TRI-CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: S0819326 . This is a "BLUE SHIELD OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 231365971 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9231 . This is a "ELDER HEALTH / BRAVO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: H19826 . This is a "INTER-CITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2353876 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 28824 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 480030054 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3Y2326 . This is a "HEALTH NET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 435767 . This is a "HEALTH AMERICA HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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