Basic Information
| Provider Information | |||||||||
| NPI: | 1619151842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | YU-PING | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEE | ||||||||
| OtherFirstName: | PAM | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C, PHARM.D., M.S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1005 N. WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | GREEN BROOK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088123339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329688900 | ||||||||
| FaxNumber: | 7329684609 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 N WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | GREEN BROOK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088122619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329688900 | ||||||||
| FaxNumber: | 7329684609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2007 | ||||||||
| LastUpdateDate: | 08/12/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 012016-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 25MP00228200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.