MEDICARE: DR. FRED LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MA063836	NJ

General Provider Information

NPI Number	:	1518035807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED LEE

Provider Business Mailing Address
First Line	:	1608 LEMOINE AVE STE 204
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5636
Country	:	US
Telephone Number	:	201-461-0708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 LEMOINE AVE STE 204
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5636
Country	:	US
Telephone Number	:	201-461-0708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. FRED LEE ” Practice Location

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