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General NPI Number Information
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NPI Number | 1336900935
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Entity Type | Organization
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Legal Business Name | PINEAPPLE PODIATRY PC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 842 CLIFTON AVE STE 6
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City | CLIFTON
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State | NJ
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Zip | 07013-1800
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Country | US
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Telephone | 212-389-6284
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Fax |
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Provider Business Mailing Address
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Address Line | 842 CLIFTON AVE STE 6
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City | CLIFTON
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State | NJ
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Zip | 07013-1800
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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 | PRESIDENT
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Name | HYUN JAE LEE
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Credential | DPM DC
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Telephone | 551-257-8394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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