Provider Demographics
NPI:1598251472
Name:LEE, JEONG EUN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JEONG
Middle Name:EUN
Last Name:LEE
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:26 CARTER ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1518
Practice Address - Country:US
Practice Address - Phone:201-290-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006127171100000X
NJ25MZ00132100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist