Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080A0000X | Adolescent Medicine | MA05821600 | NJ |
NPI | 1225149727 |
---|---|
Provider Name | Dr. J Elica Kang Lee |
First Address | Edison, NJ 08820-2704 |
Second Address | Edison, NJ 08820-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |