Provider Demographics
NPI:1043283054
Name:HANSEN, BYRON LEE (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:BYRON
Middle Name:LEE
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BUCKHAVEN HL
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1710
Mailing Address - Country:US
Mailing Address - Phone:201-939-5781
Mailing Address - Fax:201-935-0889
Practice Address - Street 1:50 STATE RT 120
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-2131
Practice Address - Country:US
Practice Address - Phone:201-939-5781
Practice Address - Fax:201-935-0889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00088000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist