Healthcare Provider Details

I. General information

NPI: 1619151842
Provider Name (Legal Business Name): YU-PING LEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAM LEE PA-C, PHARM.D., M.S.

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N WASHINGTON AVE
GREEN BROOK NJ
08812-2619
US

IV. Provider business mailing address

1005 N. WASHINGTON AVE
GREEN BROOK NJ
08812-3339
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-8900
  • Fax: 732-968-4609
Mailing address:
  • Phone: 732-968-8900
  • Fax: 732-968-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012016-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00228200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: