Healthcare Provider Details

I. General information

NPI: 1740768571
Provider Name (Legal Business Name): JUSTIN THOMAS LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

401 HADDON AVE BLDG SUITE352
CAMDEN NJ
08103-1505
US

V. Phone/Fax

Practice location:
  • Phone: 609-344-1118
  • Fax:
Mailing address:
  • Phone: 856-342-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MA11900400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: