Healthcare Provider Details

I. General information

NPI: 1831108810
Provider Name (Legal Business Name): LEE J BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 LAUREL OAK RD CHOP CARE NETWORK AT VOORHEES SPECIALTY CARE
VOORHEES NJ
08043-3505
US

IV. Provider business mailing address

100 E PENN SQ 9TH FLOOR
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 856-435-0086
  • Fax: 856-435-0091
Mailing address:
  • Phone: 267-425-9234
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD069445L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06495200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD069445L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA06495200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: