Healthcare Provider Details

I. General information

NPI: 1760944714
Provider Name (Legal Business Name): DAVID LEE BILLING JR. MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SUMMIT AVE
MONTVALE NJ
07645-1523
US

IV. Provider business mailing address

225 SUMMIT AVE
MONTVALE NJ
07645-1523
US

V. Phone/Fax

Practice location:
  • Phone: 201-472-5431
  • Fax:
Mailing address:
  • Phone: 201-472-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberTPME6883
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA12278500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number319965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: