MEDICARE: DR. JUNG DU LEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA028375	NJ

General Provider Information

NPI Number	:	1114094703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNG DU LEE MD

Provider Business Mailing Address
First Line	:	262 LINCOLN AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-1201
Country	:	US
Telephone Number	:	973-427-9065
Fax Number	:	973-427-4995

Provider Business Practice Location Address
First Line	:	220 HAMBURG TPKE STE 4A
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2132
Country	:	US
Telephone Number	:	973-942-0400
Fax Number	:	973-942-0452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	12/14/2025

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