Healthcare Provider Details

I. General information

NPI: 1639374911
Provider Name (Legal Business Name): ATHENA LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MOUNTAINVIEW BLVD
BASKING RIDGE NJ
07920-3444
US

IV. Provider business mailing address

24 HAMILTON RD
BASKING RIDGE NJ
07920-3724
US

V. Phone/Fax

Practice location:
  • Phone: 908-542-3500
  • Fax:
Mailing address:
  • Phone: 908-326-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004951-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00130700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: