Healthcare Provider Details

I. General information

NPI: 1144430968
Provider Name (Legal Business Name): DONG SEOK HAN M. DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E ALLENDALE AVE
ALLENDALE NJ
07401-2095
US

IV. Provider business mailing address

575 MAIN ST APT 10C
CHATHAM NJ
07928-2124
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-2424
  • Fax: 201-848-0062
Mailing address:
  • Phone: 973-665-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: