Healthcare Provider Details

I. General information

NPI: 1801206289
Provider Name (Legal Business Name): LEE CHRISTOPHER KOJANIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E PALISADE AVE FL GROUP2
ENGLEWOOD CLIFFS NJ
07632-1831
US

IV. Provider business mailing address

617 E PALISADE AVE
ENGLEWOOD CLIFFS NJ
07632-1831
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-7500
  • Fax:
Mailing address:
  • Phone: 201-567-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02699600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: