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General NPI Number Information
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NPI Number | 1154216000
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Entity Type | Organization
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Legal Business Name | K & L WELLNESS NP PC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 716 BROADWAY APT 1
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City | BAYONNE
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State | NJ
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Zip | 07002-4763
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Country | US
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Telephone | 201-243-6148
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Fax |
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Provider Business Mailing Address
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Address Line | 304 HICKSVILLE RD
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City | BETHPAGE
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State | NY
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Zip | 11714-3406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NP/PRESIDENT
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Name | JAE EUN LEE
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Credential |
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Telephone | 347-744-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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