Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 020674 | NJ |
Y | 213EG0000X | General Practice | 020674 | NJ |
NPI | 1003273467 |
---|---|
Provider Name | Dr. Kessy Jessica Lee |
First Address | Cherry Hill, NJ 08034-0134 |
Second Address | Cherry Hill, NJ 08034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2016 |
Last Update Date | 15/01/2016 |