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General NPI Number Information
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NPI Number | 1740768571
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Entity Type | Individual
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Provider Name | JUSTIN THOMAS LEE MD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1925 PACIFIC AVE
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-6713
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Country | US
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Telephone | 609-344-1118
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Fax |
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Provider Business Mailing Address
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Address Line | 401 HADDON AVE BLDG SUITE352
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City | CAMDEN
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State | NJ
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Zip | 08103-1505
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Country | US
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Telephone | 856-342-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 25MA11900400
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License Number State | NJ
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