MEDICARE: YU-PING LEE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	012016-1	NY
2	363AM0700X	Medical Physician Assistant	25MP00228200	NJ

General Provider Information

NPI Number	:	1619151842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YU-PING LEE PA

Provider Business Mailing Address
First Line	:	1005 N. WASHINGTON AVE
Second Line	:
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-3339
Country	:	US
Telephone Number	:	732-968-8900
Fax Number	:	732-968-4609

Provider Business Practice Location Address
First Line	:	1005 N WASHINGTON AVE
Second Line	:
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-2619
Country	:	US
Telephone Number	:	732-968-8900
Fax Number	:	732-968-4609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	08/12/2015

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Directions to “ YU-PING LEE PA” Practice Location

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