Healthcare Provider Details

I. General information

NPI: 1467552182
Provider Name (Legal Business Name): SUNG BAM WEE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 PALISADE AVE 1ST FLOOR
FORT LEE NJ
07024-6329
US

IV. Provider business mailing address

1055 PALISADE AVE 1ST FLOOR
FORT LEE NJ
07024-6329
US

V. Phone/Fax

Practice location:
  • Phone: 201-886-1200
  • Fax: 201-886-0119
Mailing address:
  • Phone: 201-886-1200
  • Fax: 201-886-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01192500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: