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General NPI Number Information
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NPI Number | 1780332999
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Entity Type | Individual
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Provider Name | AUSTIN LEE MS, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 670 N DELAWARE ST
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City | PAULSBORO
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State | NJ
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Zip | 08066-1020
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Country | US
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Telephone | 856-423-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 681 SACRAMENTO DR
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City | MANTUA
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State | NJ
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Zip | 08051-1338
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Country | US
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Telephone | 856-628-5059
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00292000
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License Number State | NJ
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