Healthcare Provider Details

I. General information

NPI: 1124289780
Provider Name (Legal Business Name): JOSEPH KIM LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 WHITE PLAINS RD
TARRYTOWN NY
10591-5104
US

IV. Provider business mailing address

4 EVES DR # A SUITE 100
MARLTON NJ
08053-3195
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-9999
  • Fax:
Mailing address:
  • Phone: 609-267-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036130533
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA09349800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: