Provider Demographics
NPI:1497359467
Name:LEE, JOOYOUNG
Entity Type:Individual
Prefix:
First Name:JOOYOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1648
Mailing Address - Country:US
Mailing Address - Phone:201-575-6822
Mailing Address - Fax:
Practice Address - Street 1:320 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1648
Practice Address - Country:US
Practice Address - Phone:201-575-6822
Practice Address - Fax:201-231-7954
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01980100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist