Healthcare Provider Details

I. General information

NPI: 1134817133
Provider Name (Legal Business Name): JIHYUN LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VER VALEN ST STE 2
CLOSTER NJ
07624-2636
US

IV. Provider business mailing address

15 VER VALEN ST STE 2
CLOSTER NJ
07624-2636
US

V. Phone/Fax

Practice location:
  • Phone: 201-784-3600
  • Fax:
Mailing address:
  • Phone: 201-784-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA13060000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: