Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 25MA09947600 | NJ |
NPI | 1073919312 |
---|---|
Provider Name | Dongyoun Deborah Lee |
First Address | Pennington, NJ 08534-2523 |
Second Address | Pennington, NJ 08534-2523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3046303 | (05) | NJ |