Healthcare Provider Details

I. General information

NPI: 1134353592
Provider Name (Legal Business Name): STEVEN LEE-KONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 404
HACKENSACK NJ
07601-1941
US

IV. Provider business mailing address

PO BOX 27036 NEW YORK PRESBYTERIAN HOSPITAL / GERERAL SURGERY OFFICE
NEW YORK NY
10087-7036
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4371
  • Fax: 551-996-0456
Mailing address:
  • Phone: 212-342-1161
  • Fax: 212-305-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA11369600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number241908-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: