Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 25MA10381600 | NJ |
N | 2086S0102X | Surgical Critical Care | 298439-1 | NY |
NPI | 1235497512 |
---|---|
Provider Name | Christina Jungeun Lee |
First Address | Livingston, NJ 07039-5672 |
Second Address | Livingston, NJ 07039-5672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 28/10/2020 |