Provider Demographics
NPI:1407527302
Name:LEE ACUPUNCTURE AND HERBS CLINIC LLC
Entity Type:Organization
Organization Name:LEE ACUPUNCTURE AND HERBS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-556-8770
Mailing Address - Street 1:172 FRANKLIN AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3228
Mailing Address - Country:US
Mailing Address - Phone:201-556-8770
Mailing Address - Fax:
Practice Address - Street 1:172 FRANKLIN AVE STE 3A
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3228
Practice Address - Country:US
Practice Address - Phone:201-556-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty