Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 060912 | NY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 06832 | NJ |
NPI | 1497190722 |
---|---|
Provider Name | Dr. Jessica S Lee |
First Address | Florham Park, NJ 07932-1508 |
Second Address | Florham Park, NJ 07932-1508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2013 |
Last Update Date | 07/08/2020 |