Individual provider Active NPI

Theresa Carol Lee, FNP-C

  • Family Nurse Practitioner
  • Englewood, NJ
National Provider Identifier
1619518453
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ00967900 Issued in NJ
Practice address
420 Grand Ave Ste 101
Englewood, NJ 07631-4141
Phone
(201) 569-7044
NPI assigned
Oct 2, 2019
Last updated
Oct 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ00967900 NJ Primary

Addresses

Primary practice location

420 Grand Ave Ste 101
Englewood, NJ 07631-4141

Mailing address

333 Willow St Apt 404
Teaneck, NJ 07666-4068
Phone (847) 877-6172

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200224002933 NJ Practitioner - Nurse Practitioner 3870920242 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Associates of Englewood PCGroup PAC ID 1355512252, 538 clinicians

Practice addresses (Care Compare)

350 Engle St
Englewood, NJ 07631-1808
Phone (201) 894-3158

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.3 of 100Reported as group
Promoting interoperability
98
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00967900NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allied Digestive Health, LLC CurrentSince Mar 15, 2021 Accepting new patients
Medical Associates of Englewood, PC CurrentSince Aug 15, 2024 Accepting new patients
Atlantic Coast Gastroenterology Associates Past Accepting new patients

Locations

350 Engle St
Englewood, NJ 07631
Phone (201) 871-6073

420 Grand Ave
Ste 101
Englewood, NJ 07631
Phone (201) 569-7044

24 Elm St
Ste 203
Harrington Pk, NJ 07640
Phone (201) 784-0123

1640 Route 88 W
Ste 202
Wall Township, NJ 08724
Phone (732) 370-2220

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1619518453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 WILLOW ST APT 404",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664068",
            "telephone_number": "847-877-6172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 GRAND AVE STE 101",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314141",
            "telephone_number": "201-569-7044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "THERESA",
        "middle_name": "CAROL",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-02",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00967900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.