Provider Demographics
NPI:1144699612
Name:HAN, MINSOK
Entity type:Individual
Prefix:DR
First Name:MINSOK
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4001
Mailing Address - Country:US
Mailing Address - Phone:917-767-7958
Mailing Address - Fax:
Practice Address - Street 1:460 SYLVAN AVE STE 205
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2923
Practice Address - Country:US
Practice Address - Phone:201-408-4754
Practice Address - Fax:201-408-4835
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70 012442111N00000X
NJ38MC00730200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor