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General NPI Number Information
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NPI Number | 1942488572
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Entity Type | Organization
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Legal Business Name | CHANG H LEE
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 120 CHARLOTTE PLACE, MIDDLE LEVEL
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632
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Country | US
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Telephone | 201-568-0118
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Fax | 201-568-7118
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Provider Business Mailing Address
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Address Line | 120 CHARLOTTE PLACE, MIDDLE LEVEL
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632
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Country | US
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Telephone | 201-568-0118
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Fax | 201-568-7118
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. CHANG HO LEE
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Credential | M.D.
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Telephone | 201-568-0118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 25MA05757200
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License Number State | NJ
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