1942488572 NPI number — CHANG H LEE

Table of content: (NPI 1942488572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942488572 NPI number — CHANG H LEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANG H LEE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PALISADE PAIN REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942488572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 CHARLOTTE PLACE, MIDDLE LEVEL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD CLIFFS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-568-0118
Provider Business Mailing Address Fax Number:
201-568-7118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 CHARLOTTE PLACE, MIDDLE LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD CLIFFS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-568-0118
Provider Business Practice Location Address Fax Number:
201-568-7118
Provider Enumeration Date:
02/06/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
CHANG
Authorized Official Middle Name:
HO
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
201-568-0118

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  25MA05757200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)