Provider Demographics
NPI:1073741682
Name:LEE, SUNG CHUL (LAC)
Entity Type:Individual
Prefix:MR
First Name:SUNG CHUL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 US HIGHWAY 46
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4062
Mailing Address - Country:US
Mailing Address - Phone:973-784-3400
Mailing Address - Fax:973-784-3400
Practice Address - Street 1:159 US HIGHWAY 46
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4062
Practice Address - Country:US
Practice Address - Phone:973-784-3400
Practice Address - Fax:973-784-3400
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00057100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist