MEDICARE: MR. BYRON LEE HANSEN MS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MT00088000	NJ

General Provider Information

NPI Number	:	1043283054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BYRON LEE HANSEN MS, ATC

Provider Business Mailing Address
First Line	:	99 BUCKHAVEN HL
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-1710
Country	:	US
Telephone Number	:	201-939-5781
Fax Number	:	201-935-0889

Provider Business Practice Location Address
First Line	:	50 STATE RT 120
Second Line	:
City	:	EAST RUTHERFORD
State	:	NJ
Zip	:	07073-2131
Country	:	US
Telephone Number	:	201-939-5781
Fax Number	:	201-935-0889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/08/2007

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