Provider Demographics
NPI:1548564842
Name:LEE, HYOJUNG
Entity Type:Individual
Prefix:
First Name:HYOJUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E BRINKERHOFF AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1557
Mailing Address - Country:US
Mailing Address - Phone:551-574-2665
Mailing Address - Fax:
Practice Address - Street 1:51 E BRINKERHOFF AVE APT 14
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1557
Practice Address - Country:US
Practice Address - Phone:551-574-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY638015163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse