Healthcare Provider Details

I. General information

NPI: 1548564842
Provider Name (Legal Business Name): HYOJUNG LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E BRINKERHOFF AVE APT 14
PALISADES PARK NJ
07650-1557
US

IV. Provider business mailing address

51 E BRINKERHOFF AVE APT 14
PALISADES PARK NJ
07650-1557
US

V. Phone/Fax

Practice location:
  • Phone: 551-574-2665
  • Fax:
Mailing address:
  • Phone: 551-574-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number638015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: