Provider Demographics
NPI:1982071577
Name:LEE, JOHN JONGHYUN (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JONGHYUN
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIVER STREET EXT APT 10
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1112
Mailing Address - Country:US
Mailing Address - Phone:732-421-4016
Mailing Address - Fax:
Practice Address - Street 1:2 RIVER STREET EXT APT 10
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1112
Practice Address - Country:US
Practice Address - Phone:732-421-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01631100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist