Healthcare Provider Details

I. General information

NPI: 1548690746
Provider Name (Legal Business Name): PEDRO YEE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 UNION AVE 1 FL
CLIFTON NJ
07011-2628
US

IV. Provider business mailing address

68 UNION AVE 1 FL
CLIFTON NJ
07011-2628
US

V. Phone/Fax

Practice location:
  • Phone: 973-772-8988
  • Fax:
Mailing address:
  • Phone: 973-772-8988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00028200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: