Provider Demographics
NPI:1164729448
Name:KANG-LEE AND JANUSZ PEDIATRICS, LLC
Entity Type:Organization
Organization Name:KANG-LEE AND JANUSZ PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-549-7007
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-0250
Mailing Address - Country:US
Mailing Address - Phone:732-549-7007
Mailing Address - Fax:732-494-9098
Practice Address - Street 1:2177 OAK TREE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1082
Practice Address - Country:US
Practice Address - Phone:732-549-7007
Practice Address - Fax:732-494-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05523200174400000X
NJ25MA03216200207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty