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General NPI Number Information
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NPI Number | 1871276360
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Entity Type | Individual
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Provider Name | JISIN LEE
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 65 N MAPLE AVE STE 202
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3233
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Country | US
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Telephone | 201-473-2981
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Fax |
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Provider Business Mailing Address
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Address Line | 51 WYANDEMERE DR
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City | WOODCLIFF LAKE
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State | NJ
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Zip | 07677-7665
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Country | US
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Telephone | 201-694-9286
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06995300
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License Number State | NJ
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