MEDICARE: DONG SEOK HAN M. DIV.

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	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1144430968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONG SEOK HAN M. DIV.

Provider Business Mailing Address
First Line	:	575 MAIN ST
Second Line	:	APT 10C
City	:	CHATHAM
State	:	NJ
Zip	:	07928-2124
Country	:	US
Telephone Number	:	973-665-1186
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 E ALLENDALE AVE
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-2095
Country	:	US
Telephone Number	:	201-327-2424
Fax Number	:	201-848-0062

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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