Active NPI
SE Min Jin
- Pharmacist
- Fort Lee, NJ
National Provider Identifier
1215645262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI04084900
- Practice address
- 1350 15TH St Apt 7H
Fort Lee, NJ 07024-2017 - Phone
- (703) 424-0208
- NPI assigned
- Nov 8, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI04084900 | NJ | Primary |
Addresses
Primary practice location
1350 15TH St Apt 7H
Fort Lee, NJ 07024-2017
Mailing address
1350 15TH St Apt 7H
Fort Lee, NJ 07024-2017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI04084900 | NJ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667865600000",
"number": "1215645262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 15TH ST APT 7H",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070242017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 15TH ST APT 7H",
"city": "FORT LEE",
"state": "NJ",
"postal_code": "070242017",
"telephone_number": "703-424-0208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIN",
"first_name": "SE MIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-08",
"last_updated": "2022-11-08",
"certification_date": "2022-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI04084900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lee, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.