| Fort Lee Internal Medicine Pc | |
|
1608 Lemoine Ave Ste 206 Fort Lee NJ 07024-5622 | |
| (917) 301-5821 | |
| Not Available |
| Full Name | Fort Lee Internal Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1608 Lemoine Ave Ste 206, Fort Lee, New Jersey |
| Authorized Official Name and Position | Jeongwon Kim (OWNER) |
| Authorized Official Contact | 9173015821 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Lee Internal Medicine Pc 279 Tremont Ave Fort Lee NJ 07024-5232 Ph: () - | Fort Lee Internal Medicine Pc 1608 Lemoine Ave Ste 206 Fort Lee NJ 07024-5622 Ph: (917) 301-5821 |
| NPI Number | 1952820623 |
|---|---|
| Provider Enumeration Date | 09/14/2017 |
| Last Update Date | 06/20/2018 |
| Medicare PECOS PAC ID | 6002182953 |
|---|---|
| Medicare Enrollment ID | O20171023000119 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952820623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 25MA09382300 (New Jersey) | Primary |
| Provider Name | Jeongwon Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831199199 PECOS PAC ID: 3173598794 Enrollment ID: I20171023000238 |
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