Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25MA06792600 | NJ |
NPI | 1003866542 |
---|---|
Provider Name | Dr. Robert Edward Lee III |
First Address | Manahawkin, NJ 08050-2414 |
Second Address | Manahawkin, NJ 08050-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7901208 | (05) | NJ |
G78926 | (02) | NJ |