Provider Demographics
NPI:1356525695
Name:DR. JIMMY KIM SEESE
Entity type:Organization
Organization Name:DR. JIMMY KIM SEESE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM SEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-944-4477
Mailing Address - Street 1:2175 LEMOINE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6001
Mailing Address - Country:US
Mailing Address - Phone:201-944-4477
Mailing Address - Fax:201-944-9998
Practice Address - Street 1:2175 LEMOINE AVE STE 302
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6001
Practice Address - Country:US
Practice Address - Phone:201-944-4477
Practice Address - Fax:201-944-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD 2346213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4106540001Medicare NSC
NJ883781Medicare PIN
NJU62252Medicare UPIN