Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA07756900 | NJ |
Y | 207QA0505X | Family Doctor - Adult Medicine | 25MA07756900 | NJ |
NPI | 1285632950 |
---|---|
Provider Name | Thomas Y Lee |
First Address | Mount Laurel, NJ 08054-2210 |
Second Address | Mount Laurel, NJ 08054-2210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 25/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I18311 | (02) | NJ |