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General NPI Number Information
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NPI Number | 1720390180
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Entity Type | Individual
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Provider Name | HAKKYUNG LEE KOVACS NPC
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Gender | Female
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Dates
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Enumeration Date | 07/13/2010
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 1031 MCBRIDE AVE SUITE C204
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2559
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Country | US
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Telephone | 973-785-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 736 WESTWOOD AVE
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City | RIVERVALE
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State | NJ
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Zip | 07675-6641
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Country | US
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Telephone | 201-952-9529
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Fax | 201-497-8901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 99280
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NN99280
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License Number State | NJ
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