Healthcare Provider Details

I. General information

NPI: 1932126703
Provider Name (Legal Business Name): NORTH JERSEY ANESTHESIA ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HAMBURG TPKE STE 4
WAYNE NJ
07470-2132
US

IV. Provider business mailing address

262 LINCOLN AVE
HAWTHORNE NJ
07506-1201
US

V. Phone/Fax

Practice location:
  • Phone: 973-942-0400
  • Fax: 973-942-0452
Mailing address:
  • Phone: 973-427-9065
  • Fax: 973-427-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA028375
License Number StateNJ

VIII. Authorized Official

Name: DR. JUNG DU LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 973-427-9065