MEDICARE: JOONGHAE LEE LAC

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	171100000X	Acupuncturist	25MZ00024800	NJ

General Provider Information

NPI Number	:	1235490483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOONGHAE LEE LAC

Provider Business Mailing Address
First Line	:	530 MAIN ST
Second Line	:	SUITE 2
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4506
Country	:	US
Telephone Number	:	201-592-6200
Fax Number	:	201-592-6401

Provider Business Practice Location Address
First Line	:	530 MAIN ST
Second Line	:	SUITE 2
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4506
Country	:	US
Telephone Number	:	201-592-6200
Fax Number	:	201-592-6401

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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Directions to “ JOONGHAE LEE LAC” Practice Location

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