Provider Demographics
NPI:1316726540
Name:YI, SUE JIN (ATR-BC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:JIN
Last Name:YI
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1324
Mailing Address - Country:US
Mailing Address - Phone:718-440-4222
Mailing Address - Fax:
Practice Address - Street 1:177 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1324
Practice Address - Country:US
Practice Address - Phone:718-440-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist