Fort Lee Internal Medicine PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA09382300 Issued in NJ

Legal business name

FORT LEE INTERNAL MEDICINE PC

Practice address

1608 Lemoine Ave Ste 206
Fort Lee, NJ 07024-5622

Phone

(917) 301-5821

NPI assigned

Sep 14, 2017

Organization subpart

No

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

Authorized official

Name

Jeongwon Kim, MDNPI 1831199199

Title

Owner

Phone

(917) 301-5821

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

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

• Jeongwon Kim, M.D.

  • Infectious Disease Physician
  • Fort Lee, NJ
  • NPI 1831199199
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1952820623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 TREMONT AVE",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070245232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 LEMOINE AVE STE 206",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070245622",
            "telephone_number": "917-301-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT LEE INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-14",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JEONGWON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-301-5821",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA09382300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fort Lee Dental
• Fort Lee First Dental Group
• Fort Lee Foot and Ankle Center PC
• Fort Lee Health Center PC
• Fort Lee Health Supplies
• Fort Lee Medical Center, Inc. (Fort Lee Surgery Center)
• Fort Lee Orthodontic Associates PC
• Fort Lee Pain Management LLC
• Fort Lee Pharmacy & Surgical Inc (Fort Lee Pharmacy & Surgicals)
• Fort Lee Pharmacy & Surgical Inc (Fort Lee Pharmacy and Surgicals Inc)

• Internal Medicine Physician in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.