Provider Demographics
NPI:1013261270
Name:LEE, SOON ZEUNG (RCS)
Entity type:Individual
Prefix:
First Name:SOON
Middle Name:ZEUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:RCS
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RCS
Mailing Address - Street 1:11-06 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2228
Mailing Address - Country:US
Mailing Address - Phone:201-546-3630
Mailing Address - Fax:
Practice Address - Street 1:11-06 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2228
Practice Address - Country:US
Practice Address - Phone:201-546-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist