1558367821 NPI number — EDWARD G LEE M.D.

Table of content: EDWARD G LEE M.D. (NPI 1558367821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558367821 NPI number — EDWARD G LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
EDWARD
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558367821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 HOSPITAL PLZ
Provider Second Line Business Mailing Address:
STE 405
Provider Business Mailing Address City Name:
OLD BRIDGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08857-3096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-946-2844
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 HOSPITAL PLZ
Provider Second Line Business Practice Location Address:
STE 405
Provider Business Practice Location Address City Name:
OLD BRIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08857-3096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-360-1133
Provider Business Practice Location Address Fax Number:
732-360-0033
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  MA04835600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0741001 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5503110 . This is a "GHI INS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0102139000 . This is a "KEYSTONE INS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223397264 . This is a "CIGNA INS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0025721 . This is a "AETNA INS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0845602004 . This is a "AMERIHEALTH INS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: LS156 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK7620 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1041554 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 290001803 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1081701 . This is a "HORIZON NJ SPECIALIST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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