Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 25MA06012300 | NJ |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MA06012300 | NJ |
NPI | 1932206521 |
---|---|
Provider Name | Derek S Lee |
First Address | Livingston, NJ 07039-4043 |
Second Address | Livingston, NJ 07039-4043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 08/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G79863 | (02) | NJ |