Healthcare Provider Details

I. General information

NPI: 1134706484
Provider Name (Legal Business Name): SEK EUN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 10/02/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100-102 COLLEGE FARM ROAD EAST
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

100-102 COLLEGE FARM ROAD EAST
NEW BRUNSWICK NJ
08901
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6888
  • Fax:
Mailing address:
  • Phone: 732-235-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MB12297000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: