NPIMap

Organization Active NPI

Sung Won Lee MD PC

  • Internal Medicine Physician
  • Palisades Park, NJ
National Provider Identifier
1144501362
Registry record updated Oct 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA08015300 Issued in NJ
Legal business name
SUNG WON LEE MD PC
Practice address
101 Broad Ave
Palisades Park, NJ 07650-1438
Phone
(201) 941-2486
Fax
(201) 941-1577
NPI assigned
Sep 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sungwon Lee, M.D.NPI 1144296492
Title
President
Phone
(201) 941-2486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MA08015300 NJ Primary
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X 25MA08015300 NJ
Obesity Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RB0002X 25MA08015300 NJ

Addresses

Primary practice location

101 Broad Ave
Palisades Park, NJ 07650-1438

Mailing address

101 Broad Ave
Palisades Park, NJ 07650-1438
Phone (201) 941-2486

Other identifiers 1

IdentifierTypeStateIssuer
0093572MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120423000545 NJ Part B Supplier - Clinic/Group Practice 9931360716 Receives reassigned benefits from 2 practitioners
Practice locations: Palisades Park, NJ

National Provider Directory

National Provider Directory

Locations

101 Broad Ave
Palisades Pk, NJ 07650
Phone (201) 941-2486

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3579/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319414400000",
    "number": "1144501362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BROAD AVE",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501438",
            "telephone_number": "201-941-2486",
            "fax_number": "201-941-1577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BROAD AVE",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501438",
            "telephone_number": "201-941-2486",
            "fax_number": "201-941-1577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNG WON LEE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-01",
        "last_updated": "2011-10-24",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SUNGWON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-941-2486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08015300",
            "primary": true
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NJ",
            "license": "25MA08015300",
            "primary": false
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "NJ",
            "license": "25MA08015300",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0093572",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palisades Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.