Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 25MA02879600 | NJ |
NPI | 1396758983 |
---|---|
Provider Name | Mr. Sang M Lee |
First Address | Warren, NJ 07059-2633 |
Second Address | Warren, NJ 07059-2633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 19/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D12905 | (02) | NJ |