=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194004671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUNG I. LEE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2011
-----------------------------------------------------
Last Update Date | 08/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2263 SAINT GEORGES AVE
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065-2109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-574-0055
-----------------------------------------------------
Fax | 732-574-1155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2263 SAINT GEORGES AVE
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065-2109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-574-0055
-----------------------------------------------------
Fax | 732-574-1155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. YOUNG I. LEE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-574-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MA28327
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MA28327
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------