1770621575 NPI number — RICHARD T LEE M.D.

Table of content: RICHARD T LEE M.D. (NPI 1770621575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770621575 NPI number — RICHARD T LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
RICHARD
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770621575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 N HARRISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-3521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-924-9300
Provider Business Mailing Address Fax Number:
609-430-9481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 N HARRISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-924-9300
Provider Business Practice Location Address Fax Number:
609-430-9481
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  25MA07210700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2564947 . This is a "AETNA HMO NONHMO PCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2179916000 . This is a "AMERIHLTH IBC SPECIALTY" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2399001 . This is a "OXFORD SPECIALTY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2564027 . This is a "AETNA HMO NONHMO SPEC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2486126 . This is a "OXFORD PCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1490073 . This is a "AMERIHLTH ADMIN SPEC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 900003868 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005550 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2080874 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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