MEDICARE: NORTH JERSEY ANESTHESIA ASSOCIATES 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	174400000X	Specialist	MA028375	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1K9165	OTHER	NJ	HEALTHNET
2	A510336	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1932126703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY ANESTHESIA ASSOCIATES PA

Provider Business Mailing Address
First Line	:	262 LINCOLN AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-1201
Country	:	US
Telephone Number	:	973-427-9065
Fax Number	:	973-427-4995

Provider Business Practice Location Address
First Line	:	220 HAMBURG TPKE STE 4
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2132
Country	:	US
Telephone Number	:	973-942-0400
Fax Number	:	973-942-0452

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUNG DU LEE
Credential	:	MD
Telephone Number	:	973-427-9065

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/22/2020

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