Provider Demographics
NPI:1467552182
Name:WEE, SUNG BAM (PT)
Entity Type:Individual
Prefix:
First Name:SUNG BAM
Middle Name:
Last Name:WEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 PALISADE AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6329
Mailing Address - Country:US
Mailing Address - Phone:201-886-1200
Mailing Address - Fax:201-886-0119
Practice Address - Street 1:1055 PALISADE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6329
Practice Address - Country:US
Practice Address - Phone:201-886-1200
Practice Address - Fax:201-886-0119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01192500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist