Healthcare Provider Details

I. General information

NPI: 1336399575
Provider Name (Legal Business Name): KATHLEEN J YU AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEE J LEE

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13-19 RIVER RD
FAIR LAWN NJ
07410-1837
US

IV. Provider business mailing address

PO BOX 23861
NEWARK NJ
07189-0861
US

V. Phone/Fax

Practice location:
  • Phone: 201-703-6800
  • Fax: 201-703-6805
Mailing address:
  • Phone: 201-692-0500
  • Fax: 201-836-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00048200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: