MEDICARE: METRO DERMATOLOGY OF NJ,PA

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	207NS0135X	Procedural Dermatology Physician

General Provider Information

NPI Number	:	1437353372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO DERMATOLOGY OF NJ,PA

Provider Business Mailing Address
First Line	:	2175 LEMOINE AVE FL 6
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6008
Country	:	US
Telephone Number	:	201-886-9000
Fax Number	:	201-227-1789

Provider Business Practice Location Address
First Line	:	2175 LEMOINE AVE FL 6
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6008
Country	:	US
Telephone Number	:	201-886-9000
Fax Number	:	201-227-1789

Authorized Official
Title or Position	:	OWNER
Name	:	HYUN SOO LEE
Credential	:	MD
Telephone Number	:	718-886-9000

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	04/15/2026

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