Provider Demographics
NPI:1710325741
Name:FUSUNYAN-LEE, JOEL CHRISTOPHER (RN)
Entity Type:Individual
Prefix:MR
First Name:JOEL CHRISTOPHER
Middle Name:
Last Name:FUSUNYAN-LEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SUSSEX BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3837
Mailing Address - Country:US
Mailing Address - Phone:484-422-8868
Mailing Address - Fax:
Practice Address - Street 1:219 SUSSEX BLVD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008
Practice Address - Country:US
Practice Address - Phone:484-422-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN601150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse