Provider Demographics
NPI:1598443657
Name:JOEL-LEAN'S LLC
Entity Type:Organization
Organization Name:JOEL-LEAN'S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL-LEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-259-7916
Mailing Address - Street 1:9206 PEABODY ST
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2523
Mailing Address - Country:US
Mailing Address - Phone:347-259-7916
Mailing Address - Fax:
Practice Address - Street 1:9206 PEABODY ST
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2523
Practice Address - Country:US
Practice Address - Phone:347-259-7916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine