Healthcare Provider Details

I. General information

NPI: 1154652949
Provider Name (Legal Business Name): SE YOUNG HAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MORRIS AVE
SPRINGFIELD NJ
07081-1151
US

IV. Provider business mailing address

465 SOUTH ST STE 200
MORRISTOWN NJ
07960-6439
US

V. Phone/Fax

Practice location:
  • Phone: 973-379-2111
  • Fax: 973-379-2807
Mailing address:
  • Phone: 973-971-7206
  • Fax: 973-898-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA10805600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: