Provider Demographics
NPI:1356853055
Name:LEE'S WELLNESS ACUPUNCTURE,PLLC
Entity Type:Organization
Organization Name:LEE'S WELLNESS ACUPUNCTURE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:WOONG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-921-3180
Mailing Address - Street 1:1217 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1710
Mailing Address - Country:US
Mailing Address - Phone:201-921-3180
Mailing Address - Fax:
Practice Address - Street 1:105 SHAD ROW # 1C
Practice Address - Street 2:
Practice Address - City:PIERMONT
Practice Address - State:NY
Practice Address - Zip Code:10968-3001
Practice Address - Country:US
Practice Address - Phone:201-921-3180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005971171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005971Medicaid