MEDICARE: MR. FENGLEI BAO

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1154083244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FENGLEI BAO

Provider Business Mailing Address
First Line	:	1165 PALISADE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6427
Country	:	US
Telephone Number	:	347-348-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 PALISADE AVE
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6427
Country	:	US
Telephone Number	:	347-348-6021
Fax Number	:

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

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	03/22/2022

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Directions to “ MR. FENGLEI BAO ” Practice Location

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