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General NPI Number Information
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NPI Number | 1922219484
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Entity Type | Organization
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Legal Business Name | METROPOLITAN EAR NOSE AND THROAT & FACIAL PLASTIC SURGERY PA
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 201 S LIVINGSTON AVE SUITE 2G
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-716-9716
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Fax | 973-716-9738
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Provider Business Mailing Address
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Address Line | 201 S LIVINGSTON AVE SUITE 2G
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4043
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Country | US
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Telephone | 973-716-9716
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DEREK S LEE
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Credential | MD
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Telephone | 973-716-9716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 25MA06012300
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License Number State | NJ
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