MEDICARE: MS. EUN JU LEE

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	363LF0000X	Family Nurse Practitioner	F339115	NY

General Provider Information

NPI Number	:	1841777299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EUN JU LEE

Provider Business Mailing Address
First Line	:	2100 LINWOOD AVE APT 14D
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-3140
Country	:	US
Telephone Number	:	718-640-7045
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 LINWOOD AVE APT 14D
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-3140
Country	:	US
Telephone Number	:	201-315-2296
Fax Number	:

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	11/25/2020

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