Healthcare Provider Details

I. General information

NPI: 1881628246
Provider Name (Legal Business Name): MARY YEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 NEPTUNE BOULEVARD SUITE 4
NEPTUNE NJ
07753
US

IV. Provider business mailing address

444 NEPTUNE BOULEVARD SUITE 4
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-4332
  • Fax: 732-774-4077
Mailing address:
  • Phone: 732-774-4332
  • Fax: 732-774-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05481300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: