Provider Demographics
NPI:1275592545
Name:HONG, LIELIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LIELIE
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 6-2
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4131
Mailing Address - Country:US
Mailing Address - Phone:201-225-4700
Mailing Address - Fax:291-225-4702
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 6-2
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4131
Practice Address - Country:US
Practice Address - Phone:201-225-4700
Practice Address - Fax:291-225-4702
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT35304207P00000X, 208000000X, 2080P0204X
NJ25MA0730692080P0204X
NJ25MA07306900207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ164306OtherMEDICARE PTAN -NJ
CTD400003312OtherMEDICARE IDENTIFICATION NUMBER -FRANKLIN MEDICAL GROUP
CTD400003312OtherMEDICARE IDENTIFICATION NUMBER -FRANKLIN MEDICAL GROUP