Healthcare Provider Details

I. General information

NPI: 1366033920
Provider Name (Legal Business Name): SUYOUNG LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 11/12/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ENGLE ST
ENGLEWOOD NJ
07631-2938
US

IV. Provider business mailing address

2619 30TH ST
ASTORIA NY
11102-1775
US

V. Phone/Fax

Practice location:
  • Phone: 201-922-4488
  • Fax:
Mailing address:
  • Phone: 516-888-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00151100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027114-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: