MEDICARE: SANG-UK LEE P.T

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1992817852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANG-UK LEE P.T

Provider Business Mailing Address
First Line	:	360 WHITEMAN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4628
Country	:	US
Telephone Number	:	201-346-0806
Fax Number	:	201-346-9656

Provider Business Practice Location Address
First Line	:	360 WHITEMAN ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-4628
Country	:	US
Telephone Number	:	201-346-0806
Fax Number	:	201-346-9656

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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